40-Year War on Cancer: Can We Win?

The signing of the National Cancer Act by President Richard M. Nixon on December 23, 1971, was considered a declaration of War on Cancer (although researchers had never slowed in their efforts to combat this multiheaded disease). The law earmarked $1.5 million for cancer research over a 3-year period and broadened the scope and responsibilities of the National Cancer Institute. Equally important, the law designated the fight against cancer a national priority.

The War on Cancer was declared at a singular time, on the cusp of the scientific triumph of the moon landing and an unpopular war in Vietnam. In December 1969, activists led by Mary Lasker published a full-page advertisement in The New York Times: “Mr. Nixon: You Can Cure Cancer.” The copy read, “Dr. Sidney Farber, Past President of the American Cancer Society, believes: ‘We are so close to a cure for cancer. We lack only the will and the kind of money and comprehensive planning that went into putting a man on the moon’.”[1]

Forty years later, Dr. Farber’s prophecy remains unfulfilled, although we have greater understanding of the biological and molecular bases of cancer in all its forms and the development of effective treatments is accelerating. By 2005, mortality rates of nearly every major form of cancer — lung, breast, colon, and prostate — had dropped continuously for 15 years.[2] Cancer-related mortality rates have declined substantially in both men and women, whether they are measured against baseline rates in 1970-71, when the National Cancer Act was initiated, or against the peak rates of incidence seen in 1990-91.[3] Still, in 2011 cancer will kill an estimated 571,950 people in the United States,[4] an indication that the War on Cancer is one of attrition.

The decline in cancer death rates has resulted primarily from reductions in tobacco use, increased screening that allows for early detection of several cancers, and modest to large improvements in treatment for specific cancers.[5] For lung cancer, the driver of the decline was most notably fueled by Surgeon Generals’ reports (beginning in 1964) and brought to full boil by anti-tobacco advertisements, culminating in national and state legislation against smoking in many public places. Growing evidence indicates that obesity will soon overtake smoking as the most preventable cause of cancer,[6] suggesting, as with smoking, that aggressive campaigns to promote exercise and weight management may be required to keep an aging population cancer free.

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