CHICAGO — As I do every year at this time, I have been covering the annual meeting of the American Society of Clinical Oncology, the world’s biggest gathering of cancer specialists. At least 33,000 medical professionals registered for this year’s meeting. The number of attendees has been climbing yearly for decades, an indication of the enormous growth of the cancer treatment industry.
In the massive commercial exhibits area, drug companies vie to attract attention for their treatments and diagnostics. Many of those products sell for tens of thousands of dollars a year for each patient and bring in billions of dollars for their manufacturers.
During conference session breaks the seemingly endless hallways of Chicago’s monstrous McCormick Place Convention Center become gorged with doctors walking at slightly crooked angles. The gait results from each carrying a conference bag filled with the huge printed programs, books of study abstracts, as well as the drug company handouts they accumulate. Those doctors, considered "thought leaders" whose prescribing patterns influence other doctors, score invitations to drug company parties at some of the cities most elegant restaurants and clubs.
In the midst of this annual frenzy, it's appropriate to ask a question that has become a cliché of medical journalism: Are we winning the war on cancer?
The inquiry has been recurring since December 23, 1971 when President Nixon signed into law the National Cancer Act, called the "War on Cancer" by those who backed it in Congress and the White House. At the signing Nixon declared, "I hope in the years ahead we will look back on this action today as the most significant action taken during my Administration."
The Act made the National Cancer Institute separate from the rest of the National Institutes of Health, with the NCI director reporting to the President. And it vastly increased funding for the NCI to $230 million that year. Today, the NCI’s annual budget is about $5 billion.
Difficult to eliminate
There is of course no simple answer to the question of progress against cancer. The word cancer applies to some 200 diseases characterized by uncontrolled cell growth. Today, a diagnosis of cancer is not the automatic death sentence that many saw it to be at the time of Nixon’s signing. Some 10 million Americans, in fact, are living with cancer.
In addition, the death rates from lung cancer — the biggest killer of all — have been dropping in men and have leveled off in women. That is due almost entirely to changes in smoking patterns that occurred decades ago.
The treatments that the lung cancer specialists here apply have little effect. In fact, one of the news announcements from this conference was that the drug Erbitux, which sells for about $17,000 a month, prolonged survival in lung cancer patients by an average of one month.
There have been small, but steady declines in other major killer cancers such as breast, colon, and prostate. Those have to do with better methods of early detection and treatment.
But when looking at the overall picture there has been shockingly little progress. In the United States between 1950 and 2005 (the last year for which data are available) the death rate from cancer declined by 5 percent, an amount that is mostly due to the decline in cigarette smoking. By contrast the death rate from heart disease fell in the same period by 64 percent!
As the population ages, more people will die of both cancer and heart disease so these figures from the American Cancer Society are adjusted to account for the aging population.
If so many more doctors are treating cancer with so many more expensive drugs why are they not doing better?
Basic research has revealed how similar cancer cells are to normal cells. That similarity makes it enormously difficult to eliminate cancer without destroying normal tissue.
There is no question that the $5 billion the government spends on cancer research is a good investment and should be increased. Indeed, adjusted for inflation it has been falling dramatically in recent years. In order to truly confront cancer, scientists need to understand far more about its basic biology.
Some cancer activists and politicians are starting to talk about a second war on cancer, or an immense, ongoing government-backed effort like the Apollo space program. If there is such a program, it would be very useful to have a discussion on how much we spend on basic research and prevention, compared to how much we spend on marginally useful treatments.
Like so many other conflicts, the "War on Cancer" does not have a clear outcome. But there is no question many have found it financially profitable.