Foreword (The Politics of Cancer- Revisited)
Cancer remains one of the deadliest forces known to mankind, as it has been for centuries. Beyond the millions of people living with cancer, millions more live in fear of one day being diagnosed with the disease. Probably everyone in the country has known someone who has struggled to overcome cancer, or who has eventually succumbed to it. Although physicians and scientists continually try to improve diagnosis and treatment of this dreaded disease, over half a million Americans will die of cancer in this year alone.
The Federal government enjoined the medical crusade against cancer in 1927 with a funding allocation for cancer research, and in 1937 Congress established the National Cancer Institute which operated with modest funding for several decades. However, it wasn't until 1971 that President Nixon declared a national "war against cancer" and the National Cancer Act was passed. At that time, Congress was led to believe that an infusion of funding devoted to cancer research could produce a cure before the American Bicentennial in 1976.
When Dr. Epstein published The
Politics of Cancer in 1978, Congress had increased the budget for the National Cancer
Institute to $872 million, from $233 million in 1971, a cure was still nowhere in sight,
and there was considerable debate as to how the war against cancer should be fought. Dr.
Epstein and many of his colleagues in the public health community argued for a more
aggressive assault on the preventable causes of cancer that people are unknowingly exposed
to on a daily basis -- at home, on the job, and in the environment -- and often at low
doses over a long period of time.
Today, the annual budget for the National Cancer Institute is over $2.5 billion, half a billion more than all of the combined budgets from the year it was founded to the year the war against cancer was declared. One thing that we have learned from this massive investment is that the hope for a simple cure was naive. The uncontrolled and destructive cell growth that can attack any part of the body is far more complex than was once thought. Although scientific knowledge about cancer has continued to expand, and significant progress has been made in new areas such as cancer genetics and improved techniques for detection, diagnosis, and treatments, the goal for a cure remains elusive and distant.
Despite NCI's growth, Dr. Epstein
contends that cancer prevention is still greatly overlooked. In 1992, Dr. Epstein and a
group of national experts and former federal officials in public health and cancer
prevention held a press conference to engage the public on this imbalance. The group
argued that the national cancer program should break from a focus on cancer treatment and
do more to reduce the number of people getting cancer in the first place. Pointing to the
continued onslaught of new cases of cancer, they urged that the NCI devote as many
resources in research and outreach for cancer cause and prevention as for diagnosis and
treatment. The NCI could then provide workers, consumers, Congress, and regulatory
agencies vital information to reduce our exposure to carcinogens in air, water, food, and
the workplace. The underlying goal of this change in policy is to reduce the rate of
people getting cancer in each age group down to a level seen in the first half of the
In recent years, the National Cancer Institute has released some seemingly encouraging news. In 1997, the NCI reported the first sustained, significant decrease in cancer mortality rates since these statistics were collected in the 1930s. More recently, in March 1998, the NCI reported that the overall rate of new cancer cases being diagnosed, or the incidence rate, increased by 1.2 percent per year from 1973 to 1990, then declined by 0.7 percent per year through 1995. The reduction occurred in three of the most common cancers, including lung, colorectal and prostate cancer. Breast cancer rates have leveled, after increasing at 1.8 percent per year. Non-Hodgkin's lymphoma had been rising at the rate of 3.5 percent per year, and is now increasing at a rate of 0.8 percent per year. The NCI reported the rate of people dying from cancer declined overall by 0.5 percent per year.
These figures sound promising, and it is easy to interpret them as significant medical achievements, and as the precursor to the eventual eradication of this disease in our generation. I wish that they were. In this book, Dr. Epstein critiques the NCI statistics and provides a skeptic's view to help us understand these figures in a historical context. The fact remains that the overall incidence of cancer is much higher than it was twenty-five years ago, and survival rates for most common cancers remain unchanged.
The direction the Federal government takes in investing public resources in cancer research should be guided in the context of an open and vibrant debate among NCI, outside experts, and the public. The Institute of Medicine recently published a set of recommendations on setting priorities at the National Institutes of Health that emphasize a need to increase public participation in the agency's funding decisions. The recommendations confirm that the public's priorities should be included in the patchwork of factors used to decide how we invest finite research dollars to improve the nation's health.
As the National Cancer Institute continues its scientific investigations, with periodic announcements of achievements, discoveries, and hopes for the future (some recent studies suggest a reason for controlled optimism), The Politics of Cancer Revisited provides a highly critical review of the current state of our nation's struggle to reduce the incidence and mortality of cancer. Twenty years ago, the author's publication brought attention to the dangers of ignoring chemical hazards in our environment. I hope this new book will reinvigorate the debate on the direction of our cancer research and prevention efforts with the aim to optimize our nation's resources to spare as many lives as possible from this deadly disease.
Congressman David Obey (D-Wisc.)