1. Losing the Winnable War against Cancer (Epstein, 1998)
We are losing the winnable war against cancer. Over recent decades, the age-standardised incidence of cancer in industrialised nations has escalated to epidemic proportions, with lifetime cancer risks in the US now approaching one in two for men and one in three for women; the estimated number of new cancer cases and deaths in 2001 are 1.3 million and 550,000 respectively (Greenlee et al., 2001). The overall increase in the incidence of all cancers in the US white population from 1950-1997 was 58 per cent of which lung cancer, primarily attributed to smoking, accounted for about 25 per cent (SEER, 1973-1997); similarly, a survey of 17 other major industrialised nations has shown that non-smoking related cancers are responsible for about 75 per cent of the overall increased incidence of cancer since 1950 (Davis and Hoel, 1990). Over the same period, non-smoking cancers in the US increased approximately as follows: prostate cancer, non-Hodgkin's lymphoma and multiple myeloma, 200 per cent; thyroid cancer, 155 per cent; testis cancer, 120 per cent; adult brain and nervous system cancer, 70 per cent; female breast cancer, 60 per cent; and childhood cancer, 35 per cent. Similar trends are reflected in federal incidence rates (Surveillance, Epidemiology and End Results) from 1973 onwards.
While cancer rates have escalated, our ability to treat and 'cure' most cancers, with the notable exception of the relatively rare childhood and testicular cancers, contrary to general impressions, has remained largely unchanged for decades. Illustratively the five-year survival rates for all cancers in the US population from 1974 to 1990 increased from 49 per cent to 54 per cent for all races, and from 39 per cent to 40 per cent for blacks.
The modern cancer epidemic cannot be explained away on the basis of increasing longevity as incidence, besides mortality, rates are adjusted (age-standardised) in cancer registries to reflect this trend (Epstein, 1998). Nor can the epidemic be largely attributed to faulty personal lifestyle factors. Although smoking is clearly the single most important cause of cancer, the incidence of lung cancer in men, but not women, is declining due to reduction in smoking, while the incidence of a wide range of non-smoking cancers is increasing at proportionately greater rates. Nor can the role of high fat diets be incriminated as a major cause of cancer, in sharp contrast to heart disease. Illustratively, not only are breast cancer rates in Mediterranean countries relatively low despite diets with up to 40 per cent olive oil fat, but also epidemiological studies over the past two decades have consistently failed to establish any causal relationship between breast cancer and the consumption of fat per se, excluding consideration of meat and dairy fats heavily contaminated with carcinogenic pesticides and industrial pollutants (Epstein et al., 1998). Finally, increasing cancer rates cannot be attributed to genetic factors which, at most, are directly implicated in well under 10 per cent of all cancers, and as the genetics of human populations cannot possibly have materially changed within just the last few decades.
What then is the predominant cause of the modern cancer epidemic? The answer is based on a strong body of scientific evidence, incriminating the role of run-away industrial technologies, particularly the petrochemical and radionuclear, whose explosive growth since the 1940s has, to varying degrees in different nations, outstripped the development of social control infrastructures and mechanisms. Resultingly, our total environment - air, water, consumer and medicinal products, and the workplace - has become pervasively contaminated with a wide range of industrial carcinogens, particularly persistent organic pollutants (POPS) such as organochlorine pesticides. As a consequence, the public-at-large has been and continues to be unknowingly exposed to avoidable chemical and radionuclear carcinogens from conception to death. These conclusions have been strikingly confirmed by the results of a large scale study on identical twins in Sweden, Denmark and Finland (Lichtenstein et al., 2000). 'The overwhelming contribution to the causation of cancer in the population of (90,000) twins that we studied was the environment -. Even for cancers for which there is statistically significant evidence of a heritable component, most pairs of twins were discordant for the cancer - indicating that - the increase in the risk of cancer even among close relatives - is generally moderate'.
We are thus faced with an unparalleled crisis of international proportions. This crisis will be further exacerbated with the growing industrialisation of relatively underdeveloped European nations, such as Greece, Spain and Portugal, besides Third World countries.
How have those institutions charged with fighting the war against cancer responded to this crisis? In the US, the predominant complex of responsible institutions, known as the 'cancer establishment', is comprised of the governmental National Cancer Institute (NCI) and the private 'charity' the American Cancer Society (ACS), together with their national network of funded university scientists and Comprehensive Cancer Centers. The cancer establishment has massive resources at its disposal. The 2001 budget of the NCI is $3.8 billion, up from $220 million in 1971 when President Nixon declared the 'War Against Cancer' in response to cancer establishment pressures and demands for increased funding with the highly misleading promise that this would enable the conquest of cancer by 1987. The current budget of the ACS is about $700 million, with cash reserves and other assets of $900 million.
The policies and priorities of the cancer establishment are narrowly fixated on damage control - diagnosis and treatment - and basic molecular research with, not always benign, indifference to cancer prevention (Epstein, 1998). For the ACS, this indifference reaches the level of overt hostility (Epstein, 1999a; Cancer Prevention Coalition, 1999; Epstein and Gross, 2000). These and other concerns relating to fiscal malpractice have led the Chronicle of Philanthropy, the authoritative US charity watch dog, to charge that the ACS is 'more interested in accumulating wealth than saving lives'. ACS allocations for all primary prevention activities are under 0.1 per cent of its budget. NCI's budgetary allocation for occupational cancer, the most avoidable of all cancers, which according to conservative estimates is responsible for about 10 per cent of all US cancer deaths besides being a major cause of childhood cancer, is only 1 per cent; the budget for research and outreach on African-American and other ethnic minorities, with their disproportionately high cancer rates, is also only 1 per cent of NCI's budget. NCI's allocations for all primary prevention activities are well under 5 per cent.
The establishment's professional mindset and priorities are compounded by disturbing conflicts of interest, particularly for the ACS, with the cancer drug and other industries. As NCI's previous director Dr. Samuel Broder recently admitted, the NCI has become 'what amounts to a governmental pharmaceutical company' (Epstein, 1998). The establishment's myopic mindset is further illustrated by a succession of widely publicised misleading claims to have turned 'the tide against cancer', and for the latest 'miracle' or 'magic bullet' cancer drugs, claims which rarely have ever been subsequently substantiated, let alone recanted, over the last four decades (Epstein, 1998).
Most seriously, the poorly accountable US cancer establishment has failed to provide Congress, regulatory agencies and the public with available scientific information on a wide range of avoidable carcinogenic exposures. As a result, corrective legislative and regulatory action has still not yet been taken, and the public has been and still is denied its right-to-know of such information and the opportunity to take action to reduce its own risks of cancer. At the same time the US, Canadian, UK and other cancer establishments, still explicitly rely on obsolete and gerrymandered data and biased claims by industry-indentured academic and institutional apologists in the US and UK, particularly Sir Richard Doll (Epstein, 1998; Walker and Doll, 1998; Epstein, 1999b). For over two decades, Doll has persisted in his attempts to trivialise escalating cancer rates and to explain them away on the virtually exclusive basis of 'blame-the-victim' or faulty lifestyle causation coupled with 'guesstimates' to the effect that 'pollution [and] industrial products' account for only 3 per cent of cancer mortality (Epstein, 1998). The reliability of Doll, besides his strong conflicts of interest, as the alleged leading international expert on public health and cancer causation is even more strikingly challenged by his invidiously unique insistence that neither leaded petroleum, radiation from atom bomb tests, low level radiation, diesel exhaust or dioxin pose any public health hazards (Walker and Doll, 1998).
Based on fully documented analysis of such evidence, the US and UK cancer establishments have been recently charged with major responsibility for losing the winnable war against cancer (Epstein, 1998). This serious charge against the NCI and ACS comes as no surprise, having been first raised by the author at a February 4, 1992 Washington, D.C. press conference by an ad hoc coalition of some 65 leading national US experts in public health, preventive medicine and cancer prevention, including past directors of major federal agencies (Epstein, 1998). These concerns are all the more serious in view of the strong influence that US cancer establishment policies exerts on those of Canada, the UK and other nations world-wide, and their mutually reinforcing and interlocking relationships; as disclosed at a recent press conference, the policies of the UK cancer charities are as gravely derelict and conflict ridden as those of the US (Epstein, 1999b).