This week's Retro Report video examines the "war on cancer" — a federal research initiative authorized by President Richard M. Nixon in 1971. Many anticipated quick results, in part because of the public relations campaign, complete with ads suggesting we could cure cancer by the bicentennial, that successfully pushed Mr. Nixon into making the commitment.
Since then, the United States government has spent over $100 billion on research. For a look at the course of the war on cancer, watch the video above. And here, a veteran medical reporter who wrote a 2009 series about cancer, Forty Years' War, reflects on the progress of recent years.
It was 2008 and a woman my editor and I knew had just died of cancer. One of the last things she said to my editor was a bitter lament: "What ever happened to the" [expletive] "war on cancer?"
Well, I told my editor, it was clear we hadn't won that war. But the question was why. Why was progress so slow? Was it that cancer is a difficult disease or was it that other impediments got in the way? I thought it was probably that cancer was hard to fight. But it turned out that was only part of the problem.
Much money was being spent, but not always wisely, medical experts said.
There were federal grants ostensibly about cancer that were only tangentially related. It reminded me of my days as a molecular biology graduate student. A friend was studying the expression of genes in bacteria that were involved in lactose metabolism. He got a grant from the arthritis institute of the National Institutes of Health. I asked him how he ever accomplished that and he explained that if you write your proposal correctly you can make bacteria gene expression sound relevant to almost anything.
There also was money squandered on clinical trials that were so unimaginative and so uninteresting that they dwindled away, unable to recruit enough patients to come to any conclusions.
There were national campaigns to get people screened for cancers, even though many types of cancer screening have not been found to reduce death rates. Screening also leads doctors to find and aggressively treat cancers that would never have grown or spread or caused a problem if they had never been found and had been left alone. The only screening tests that do reduce death rates, studies have found, are Pap tests for cervical cancer, any of the three screening tests for colon cancer — colonoscopy, fecal occult blood tests or sigmoidoscopy — and a lung cancer screening test for smokers.
The much touted recent drops in some cancer rates were mostly attributable not to cancer breakthroughs but to a decline in smoking that began decades ago — propelled, in part, by federal antismoking campaigns that began in the 1960s.
Another drop in cancer rates was a consequence of something totally unrelated to the war on cancer. In 2002, a large federal study, the Women's Health Initiative, stopped early because it was finding that the treatment being tested, hormone therapy for menopausal women, had harms outweighing any benefit. Women immediately stopped taking the drugs. It turned out that one of the harmful effects was a slightly increased risk of breast cancer. When women stopped taking the hormones, an estrogen and a progestin, the breast cancer rate finally fell — the first time that had happened — by almost the exact amount predicted if women stopped taking the pills.
So it looked like progress against cancer had not come from the "war" so much as from other events. And it looked like cancer was just about as formidable as ever.
But that was in 2008. Now scientists seem to be entering a new era of optimism.
It began with insights from the much ballyhooed and then much maligned Human Genome Project. The project, to determine the sequence of human DNA, at first used expensive and laborious methods but as it went on, scientists developed much cheaper and faster ways of sequencing. With fast sequencing, the cancer institute sponsored large studies of cancer genomes, looking for mutations that seem to drive tumor growth. And drug companies looked on their own for critical cancer mutations that might make good targets for drugs.
The results are dozens of drugs that attack various mutated genes in cancer cells. The drugs are just now starting to enter the market. A few of the older ones, like Herceptin and Gleevec, developed before the new sequencing methods evolved, have made previously untreatable cancers treatable. Gleevec has turned certain blood cancers from a lethal cancer into a manageable chronic disease. Herceptin has made a form of breast cancer with the worst prognosis into one that now has the best prognosis.
But the problem with the new targeted drugs is that just as bacteria grow resistant to antibiotics, so cancers almost inevitably grow resistant to a drug that attacks a crucial mutation. The new targeted drugs can buy patients with metastatic cancer time, and, eventually, by combining drugs, scientists might be able to bar all cancers' escape routes. But for now, the new drugs rarely are cures, and they also are incredibly expensive, usually costing well over $100,000.
On the horizon is yet another sort of treatment. It unleashes the immune system, allowing it to kill cancer cells. These drugs are only starting to be developed, but some patients have had astonishing responses. Companies and researchers are buoyant, though they are also mindful of previous failed drugs and are wary of overpromising.
One way to look at the era researchers say they are entering is to say that the war on cancer was the impetus. It spurred interest in the disease and as a result money flowed to basic research. Another way to look at it is to say basic research was the key and the war on cancer was incidental.
But whether the war on cancer was more slogan or solution, most researchers believe cancer treatment, at least, is starting to change. After decades of little progress, they now are starting to go beyond the old mainstays (chemotherapy, surgery and radiation) that have never been enough against this disease.
The biggest challenge, prevention, remains. And other than stopping smoking, nothing yet has been terribly promising.
http://www.nytimes.com/2013/11/04/booming/hopeful-glimmers-in-long-war-on-cancer.html?
