Center for Health, Environment and Justice
Everyone's BackyardScience Feature
The War Against Cancer ... 27 Years and Counting
In March 1998, the National Cancer Institute (NCI), the American Cancer Society (ACS), and the Centers for Disease Control (CDC) jointly released a statement claiming a reversal of "an almost 20-year trend of increasing cancer cases and deaths." "These numbers are the first proof that we are on the right track" claimed NCI Director Richard Klausner. The New York Times said we "... may have reached a turning point in the war on cancer." Most of the media covered this story as well, with little critique of the official optimistic line.
A 1996 NCI press release reported a "nearly 3% reduction" in cancer deaths from 1991 to 1995. This marked the first decline since the start of data collection in the early 1970s. Health and Human Services Secretary Donna Shalala described this reduction as a "...turning point in the 25- year war on cancer and it should be a cause for celebration by every American." This press release was also widely covered by the media.
Millions of people now live with cancer and millions more live in fear of one day being diagnosed. This year alone over 500,000 people will die from cancer and more than 1.5 million will be diagnosed with cancer. On average, one out of every two men and one out of every three women will be diagnosed with cancer in their lifetime.
Despite this grim picture, government and industry would have us believe that we are beating the disease, in a national "war on cancer" declared in 1971 by President Richard Nixon. The federal government began pouring huge amounts of money into cancer research as part of the "war." The NCI, which until that time had only modest funding, saw its budget grow from $233 million in 1971 to $872 million by 1978. Today the NCI's budget is $2.6 billion.
Not surprisingly, there is another side to this story and it's not so rosy a picture. In the case of the two government announcements mentioned above, the tremendous press coverage was hardly justified by the data. The change in death rates announced in 1996 was actually a decline of less than one percent per year over a 4-year period. This is in the face of a steady increase in cancer death rates over the prior 40 years. Good news, but hardly enough to warrant the banner headlines that seemed to offer such hope.
John Bailar, a physician at the Department of Health Studies at the University of Chicago and an internationally renowned epidemiologist, put this finding in proper perspective in an editorial in The New England Journal of Medicine, when he wrote that "the war against cancer is far from over. Observed changes in mortality due to cancer primarily reflect changing incidence or early detection. The effect of new treatments for cancer on mortality has been largely disappointing. The most promising approach to the control of cancer is a national commitment to prevention, with concomitant rebalancing of the focus and funding of research."
Similarly, the decrease in the overall number of cancer cases announced in 1998 was not statistically significant nor were specific decreases in rates of leukemia and prostate cancer. (The NCI acknowledged that the decreased incidence of prostate cancer was likely due to less use of the prostate-specific antigen (PSA) screening test for the disease in the early 1990's, after the accuracy of the test was questioned.) While there were significant decreases in lung cancer, colon/rectal, and bladder cancer, there were also significant increases in childhood cancers, uterine and testicular cancers, melanoma, and non-Hodgkin's lymphoma. Breast cancer showed no decline.
Why the conflicting data and the overstated headlines which tried to convince the American public that we are winning the war against cancer? Common sense tells us that we're not winning this war. We're not winning when one out of every two men and one out of every three women will get cancer, up from an average of one in six in the 1960s. We're not winning when over 500,000 people will die in 1998 from cancer, up from 390,000 in 1978. We're not winning when, 27 years after declaring "war," more people than ever get cancer.
No one has done more to help the public understand the war on cancer than Dr. Samuel Epstein, professor of Occupational and Environmental Health at the School of Public Health of the University of Illinois Medical Center in Chicago. Epstein has written an excellent new book called The Politics of Cancer, Revisited which provides not only a first rate scientific analysis of cancer data, but a clear description of how the politics behind the numbers and the "cancer establishment" (the NCI and ACS) have influenced cancer research in this country.
The epilogue to The Politics of Cancer, Revisited provides insight into why we are losing the war against cancer:
"Over recent decades, the incidence of cancer has escalated to epidemic proportions while our ability to treat and cure most cancers remains virtually unchanged. Apart from the important role of tobacco, there is substantial and long-standing evidence relating this epidemic to involuntary and avoidable exposures to industrial chemicals in air, water, the workplace, and consumer products. Nevertheless, the priorities of the cancer establishment, the NCI and ACS, remain narrowly fixated on damage control - diagnosis and treatment - and on basic molecular research, with relative indifference to, if not always benign neglect of, prevention. Concerns over this imbalance are further complicated by serious questions of interlocking interests, particularly with the multibillion dollar cancer drug industry.
"In spite of overwhelming resources at its disposal, the cancer establishment has failed to allocate minimal priorities to research on cancer prevention. It has also failed to provide Congress and the Executive with well documented evidence on avoidable causes of cancer that would enable development of corrective legislative and regulatory action. Nor have U.S. citizens been advised of such information which remains buried in confidential government and industry files or is relatively inaccessible in the scientific literature, to enable them to protect themselves. Even more seriously, both government and the public have been misled by repeated claims that we are "winning the war against cancer" and that we have "turned the tide against cancer." These claims are based on extravagant and unfounded announcements of dramatic advances in conventional treatment, coupled with highly prejudicial and unfounded attacks on alternative therapies. With this background, there has been little if any pressure on industry or incentive to phase out the manufacture, use, and disposal of carcinogenic chemicals and products and to replace them with safer alternatives.
"In short, the NCI and the ACS bear major responsibility for losing the winnable war against cancer. This failure is belatedly forcing realization that right-to-know citizen initiatives, on both personal and political levels, are the basis for the mostly practical and effective strategies for winning the losing cancer war. In addition to these initiatives, the National Cancer Act should be explicitly amended to reorient the mission and priorities of the NCI to cancer cause and prevention. ACS policies will remain impervious to reform absent well orchestrated threats of economic boycott.
"In view of the powerful influence of the U.S. cancer establishment over the policies of most major industrialized nations, the message of this book is truly global rather than just national."
The war on cancer is as much as about the politics of the cancer establishment and how it has been influenced by the drug and chemical industries as it is about increases or decreases in cancer rates. While there have been important advances in diagnostic methods and in some treatments, we will continue to lose the war against cancer until the "cancer establishment" takes seriously the need to prevent exposures to avoidable carcinogens. According to Epstein, only three percent of NCI's $2.6 billion budget for 1997 was spent on prevention. The balance was spent on diagnostic and treatment methods and on basic molecular research. This cannot continue.
America's corporations make billions using chemicals which can cause cancer and they are not going to give up business as usual without a fight. Instead, they hire scientists who point to smoking, diet, and lifestyle as the main causes of cancer, not the use of industrial chemicals. This blame the victim approach is carefully debunked by Epstein who argues that there is "scant scientific basis for the lifestyle theory, and that it is in fact contradicted by a substantial body of published evidence."
Lois Gibbs put this issue in the proper context several years ago, when she appeared before the President's Cancer Advisory Board. The Board's director, Armand Hammer, had offered one million dollars to anyone who could find the cure for cancer. Lois made her claim by stating that if chemical companies like Hammer's own, Occidental Petroleum, would stop releasing carcinogens into the air, water and soil, then we would not have as much cancer. Although Hammer refused to give Lois her award, she had the right idea. If we reduce or eliminate the known cancer causing chemicals from the food we eat, the air we breathe, and the water we drink, then the risks of getting cancer will certainly go down and we will start to truly win the "war" against cancer.
Note: Excerpt from The Politics of Cancer, Revisited reprinted with permission from East Ridge Press, Fremont Center, New York, (800) 269-2921.
Originally published in Everyone's Backyard, Vol. 16, No. 4 (Winter 1998-1999)Center For Health Environment and Justice
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