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 century.
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.)
August 5, 1998
Back to The Politics of Cancer
