In 1971, flush with the nation’s success in putting a man on the Moon, President Richard M. Nixon announced a new goal. Cancer would be cured by 1976, the bicentennial.
When 1976 came and went, the date for a cure, or at least substantial progress, kept being put off. It was going to happen by 2000, then by 2015.
Now, President Barack Obama, discussing his plans for health care, has vowed to find “a cure” for cancer in our time and said that, as part of the economic stimulus package, he would increase federal money for cancer research by a third for the next two years.
Cancer has always been an expensive priority. Since the war on cancer began, the National Cancer Institute, the federal government’s main cancer research entity, with 4,000 employees, has alone spent $105 billion. And other government agencies, universities, drug companies and philanthropies have chipped in uncounted billions more.
Yet the death rate for cancer, adjusted for the size and age of the population, dropped only 5 percent from 1950 to 2005. In contrast, the death rate for heart disease dropped 64 percent in that time, and for flu and pneumonia, it fell 58 percent.
Still, the perception, fed by the medical profession and its marketers, and by popular sentiment, is that cancer can almost always be prevented. If that fails, it can usually be treated, even beaten.
The good news is that many whose cancer has not spread do well, as they have in the past. In some cases, like early breast cancer, drugs introduced in the past decade have made an already good prognosis even better. And a few rare cancers, like chronic myeloid leukemia, can be controlled for years with new drugs. Cancer treatments today tend to be less harsh. Surgery is less disfiguring, chemotherapy less disabling.
But difficulties arise when cancer spreads, and, often, it has by the time of diagnosis. That is true for the most common cancers as well as rarer ones.
With breast cancer, for example, only 20 percent with metastatic disease — cancer that has spread outside the breast, like to bones, brain, lungs or liver — live five years or more, barely changed since the war on cancer began.
With colorectal cancer, only 10 percent with metastatic disease survive five years. That number, too, has hardly changed over the past four decades. The number has long been about 30 percent for metastatic prostate cancer, and in the single digits for lung cancer.
As for prevention, progress has been agonizingly slow. Only a very few things — stopping smoking, for example — make a difference. And despite marketing claims to the contrary, rigorous studies of prevention methods like high-fiber or low-fat diets, or vitamins or selenium, have failed to find an effect.
What has happened? Is cancer just an impossibly hard problem? Or is the United States, the only country to invest so much in cancer research, making fundamental mistakes in the way it fights the cancer war?
Researchers say the answer is yes on both counts. Cancer is hard — it is not one disease
More ...http://www.nytimes.com/2009/04/24/health/policy/24cancer.html?_r=1&th=&emc=th&pagewanted=all
