Evaluation of the national cancer program and proposed reforms

Are we winning or losing the war on cancer? Deciphering the propaganda of NCI's 33-year war

The National Cancer Institute (NCI) and collaborating agencies have proclaimed great progress in the U.S. "war on cancer," while at the same time presenting more reasons for concern than celebration. We reviewed various documents and data files and found that incidence and mortality rates for all cancer sites combined remain higher than they were when the "war on cancer" was declared in 1971, despite very recent, modest decreases. The burden of the disease has risen from three million to nearly ten million people. Black Americans, men of all races, and other segments of the population disproportionately bear the burden of cancer. We also looked at data for malignant breast cancer and found that incidence rates increased 36% from 1973 to 2000, while mortality for all population groups combined declined slightly. Breast cancer mortality is 34% higher among black women than among white women, even though white women are generally more likely to get the disease. The $50 billion spent on the "war on cancer" over the last 33 years has yielded few gains. The NCI's resources must be refocused on preventing cancers we know how to prevent.

The crisis in U.S. and international cancer policy

The incidence of cancer in the United States and other major industrialized nations has escalated to epidemic proportions over recent decades, and greater increases are expected. While smoking is the single largest cause of cancer, the incidence of childhood cancers and a wide range of predominantly non-smoking-related cancers in men and women has increased greatly. This modern epidemic does not reflect lack of resources of the U.S. cancer establishment, the National Cancer Institute and American Cancer Society; the NCI budget has increased 20-fold since passage of the 1971 National Cancer Act, while funding for research and public information on primary prevention remains minimal. The cancer establishment bears major responsibility for the cancer epidemic, due to its overwhelming fixation on damage control--screening, diagnosis, treatment, and related molecular research--and indifference to preventing a wide range of avoidable causes of cancer, other than faulty lifestyle, particularly smoking. This mindset is based on a discredited 1981 report by a prominent pro-industry epidemiologist, guesstimating that environmental and occupational exposures were responsible for only 5 percent of cancer mortality, even though a prior chemical industry report admitted that 20 percent was occupational in origin. This report still dominates public policy, despite overwhelming contrary scientific evidence on avoidable causes of cancer from involuntary exposures to a wide range of environmental carcinogens. Since 1998, the ACS has been planning to gain control of national cancer policy, now under federal authority. These plans, developed behind closed doors and under conditions of nontransparency, with recent well-intentioned but mistaken bipartisan Congressional support, pose a major and poorly reversible threat to cancer prevention and to winning the losing war against cancer.