The National Cancer Institute's annual report to the nation, released Thursday, confirms what cancer experts have been suggesting for the past decade -- the war on the disease is now a winning proposition, with fewer cases occurring and fewer people dying.
The report, which covers the years 1975 to 2001, reveals from 1999 to 2001 there was a decrease of 0.5 percent per year in the number of cancers, while the death rate from all cancers dropped by 1.1 percent per year from 1991 to 2001.
Perhaps the most welcome news is lung cancer death rates in women leveled off between 1995 and 2001, after steadily increasing for years. Also, in an indication that women may indeed have "come a long way, baby," lung cancer in women also is on the decline.
Though the stats in this year's cancer report are grabbing headlines, the reality is this year's numbers simply are continuing a trend started in the early 1990s.
Dr. Robert Young, president of Fox Chase Cancer Center in Philadelphia and a past president of the American Cancer Society, told United Press International the success story in cancer is like "a giant battleship changing course. It isn't that easy to change course, but once you do change course it is pretty easy to keep going in the same direction."
How was this course change accomplished? The best answer is one word: slowly.
In 1971, President Richard M. Nixon issued the famous "war on cancer" proclamation when he signed into law the National Cancer Act. During the opening stages of the war, there was a lot of excitement involving terms such as "magic bullets" and "cures." But just as the ancient 30 Years War ravaged Europe in the 15th century, this modern war -- now 33 years old -- initially seemed to be a losing proposition, marked by false starts and wrong turns.
For example, there was a great deal of optimism about bone marrow transplantation as a possible treatment for breast cancer and many centers began offering this treatment -- without waiting for studies to prove it worked. When the studies finally were completed in the late 1990s, the results suggested bone marrow transplant did not improve outcome for women with breast cancer.
Likewise, countless numbers of so-called miracle drugs worked very well in animal models of cancer, but they failed to produce significant results when tested in humans. To many observers, it seemed at the time the war on cancer was being won in mice and lost in humans.
Throughout the last three decades, however, a series of small but persistent advances -- in prevention, detection and treatment -- have combined to produce the significant survival benefits that now seem common.
For example, the finding that lung cancer in women is on the decline is particularly significant because "lung cancer follows tobacco use by about 20 years," Young said. So the leveling off of lung cancers deaths and the decline of lung cancer cases in women suggests the no-smoking message finally is getting through to women -- a group that began picking up cigarettes as men started putting them down. That, he said, is an excellent example of the value of cancer prevention programs.
Ahemdin Jemal, lead author of the NCI's report and program director for cancer surveillance at the American Cancer Society in Atlanta, told UPI the good news in this year's report is the "result of a host of different factors. One cannot attribute the gain to one thing. Prevention is one aspect ... another is early detection, and finally advances in treatment."
The years since 1971 have witnessed significant improvements in cancer screening programs. Mammography, for example, now uses digital technology to see microscopic tumors that would have been undetectable 10 years ago. The prostate specific antigen or PSA test allows doctors to check for prostate cancer with a blood analysis -- although the test remains controversial because of concerns about reliability as well as evidence it may lead to unnecessary biopsies and/or surgery.
Dr. Louis Harrison, clinical director of the Continuum Cancer Centers of New York, said advances in all types of cancer treatment -- chemotherapy, radiation and surgery -- also have contributed to the improved survival statistics. For example, he said, chemotherapy, which uses powerful toxic agents to kill cancer cells, has been refined so it is more targeted, thereby "killing more cancer cells and doing less harm to healthy tissue."
Radiation therapy has been improved to the point where it can be targeted directly at the tumor by a variety of methods, including implanting radioactive seeds deep inside tumors and using highly accurate, pinpoint radiation beams to target tumors.
Likewise, surgeons have been learning to cut away cancers using microscopic instruments and band-aid size incisions, both making recovery from surgery faster and less painful.
One of the biggest advances in cancer treatment, Harrison said, is the development of drugs that can treat the side-effects of chemotherapy --nausea and anemia -- which cause fatigue. But though these drugs provide significant improvements in the quality of life of patients, "they are among the most expensive drugs. So paying for these drugs, and getting them to patients, is a real challenge," he said.
Moreover, paying for any type of cancer-associated care can be a challenge. Two years ago a study published in the journal Cancer found as treatments improved, costs skyrocketed. The authors compared insurance claims from people in health maintenance organizations who received cancer treatments in 1995 and 1998 and found the average cost of an outpatient chemotherapy treatment went from $1,218 in 1995 to $2,003 in 1998. The cost of chemotherapy is much higher now because, typically, three or more treatments are required in each cycle and often four or more cycles are required.
High cost is not the only downside to the cancer story. The simple truth is the war is not being won on all fronts.
Major challenges remain, said Brenda Edwards, associate director of surveillance at the National Cancer Institute in Bethesda, Md. Kidney, liver and pancreatic cancers remain major challenges. In fact, liver cancer is increasing, most likely because of the increase in both hepatitis B and hepatitis C, but there could be other factors as well, Edwards said. All three cancers also defy early detection, so in many cases the disease is diagnosed only in its later stages.
Nonetheless, the report concludes the outlook is optimistic and that view seems fairly pervasive within the cancer research and treatment community, which is gathering this weekend in New Orleans for the American Association of Clinical Oncology meeting, the largest worldwide conference of cancer experts.
Though those experts are not donning rose-colored glasses, there is every expectation that the cancer treatment news will be even better in a few years. By then, the annual cancer report will reflect the impact of new targeted therapies, such as Gleevec, the cancer pill that is effective for treatment of chronic myeloid leukemia and a rare type of stomach cancer called gastrointestinal stromal tumors.
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Peggy Peck covers medical research and health issues for UPI Science News. E-mail [email protected]
