Are we winning the war against cancer?

Numerous bulletins to the public from time to time have announced our progress in the fight against cancer, advising of breakthroughs or significant inroads against this disease, in the form of new drugs and treatments, preventive measures, dietary updates, major discoveries and advances and financing. And much of the population has become involved in this fight. Such activities as the Race for the Cure and similar events have attracted hundreds of thousands nationwide to become personally involved in the ongoing endeavor to defeat this disease.

As a result it is felt by many that these activities, in combination with the frequent communiques that the incidence of one form or another of cancer was decreasing--was being trimmed--by major advances, that the "cure" was just around the corner, that we are on the verge of significantly silencing this ruthless killer.

But is this the case?

Unfortunately, it is not. In an investigative report to the public in the April 24, 2009, issue of The New York Times, respected science writer Gina Kolata reports that 'As Other Death Rates Fall, Cancer's Scarcely Moves.' In this article the author indicates that in the last 60 years, for example, the death rate--the number of deaths adjusted for population age and size--has plummeted for heart disease, stroke and other disease modalities. But for cancer it has hadly budged.

Kolata indicates the decrease in death rate for cancer in those 60 years is only 5 percent, compared to a decrease of 67 percent for heart disease in that same time.

But is death rate a credible measure of progress in cancer? Yes, researchers say. While death rates are not perfect, they are considered the most valid measure, used by the American Cancer Society and the National Cancer Institute to assess progress in this disease.

But why?-- Why has there been virtually no progress in cancer death rates in the last half-century or more? Because of the lack of "transforming discoveries" in prevention and treatment, according to scientists quoted in this New York Times article. What is a "transforming discovery?" It is a major discovery capable of interdicting a disease or disease process. An example of a 'transforming discovery' in treatment would be the advent of insulin, whose discovery virtually normalized the lives of millions of diabetics the world over. A 'transforming discovery' in prevention would be the Salk polio vaccine, the first medical treatment which prevented the contraction of poliomyelitis in millions of people worldwide and brought this disease to a virtual standstill in every nation on earth. Transforming discoveries have the capacity to beneficially affect great portions of the population.

Have there been any 'transforming discoveries' in cancer? In order to have a transforming discovery, one has to first undertand the disease. In the case of cancer, we don't even know what cancer is. Is it a disease? Is it more than one disease? Is it caused by heredity? By diet? By viruses? Bacteria? DNA mutations? Environmental pollution? We don't know. And until we know--and can understand--we are not likely to come up with a 'transforming discovery.'

So which is correct? The constant barrage of promising new advances that are causing cancer mortality and incidence to decrease in the general population, that we are on the verge of curing major cancers? --Or that the death rate in cancer has virtually not improved in the last 50 years--i.e., since the advent of modern cancer treatment?

Have the messages meted out to the public by the cancer establishment--the cancer organizations, the pharmaceutical industry, the academic institutions, the medical news media--been misleading, evasive?

We must decide this. If we decide that the decades-long death rates in this disease have remained stationary, we must send a message to our cancer leadership: and that message must be that we will no longer be duped into believing significant progress is being made, when statistics show it is not. That we will no longer contribute our energies, our resouces or acceptance to another decade of pursuing the same tired, old methods in defeating this disease.

We must send a message to our cancer leadership that the reason the death rate in this disease has remained the same--is that obviously there is something wrong with the way we understand cancer. Something wrong in what our comprehension of this disease is. Something wrong perhaps with our equation of the tumor with cancer.

For the past half-century or more our attention has been focused on the tumor. But all attempts to treat the tumor--to kill the tumor and therefore wipe out the disease--have in general been futile. Cytotoxic chemotheray, the major weapon to defeat cancer in the last 50 years, has succeeded in killing cancer cells, but in killing normal cells, too, and has been itself a cause of cancer mortality. Even the newer methods of treating this disease, genetic, monoclonal (antibodies) and other recombinant therapies, are posing limitations due to drug resistance and major drug toxicity. Every "push" we have made against the cancer, the cancer has seemed to "push back" harder.

In the case of diabetes we have made a basic understanding that the clinical symptoms of this disease--which kill patients--are due to a basic lack of insulin. A lack of a hormonal agent that facilitates the entry of glucose into a cell. We did not make the mistake of thinking that in diabetes it was the cells themselves that were "resistant" to the entry of glucose. That there was some pathologic process inherent in the body's cellular makeup that caused the cells to resist the passage of glucose. We did not spend our nation's entire bankroll or direct our country's almost total research programs to "fixing" the cell so that it would admit glucose. The discovery of insulin was indeed a "transforming discovery."

We must now do the same with cancer. It is obvious that treatment of the"tumor" will bring us more of the same, as in the last 50 years. It is obvious that the "tumor" is but the endpoint of the cancerous process, that the "tumor" is not the same as "the cancer." It is obvious that what have 'led up' to the tumor--the biochemical processes that have "caused" the tumor--are the vulnerable aspects of cancer where drug therapy may indeed be effective in stopping or reversing the cancerous process. Until we can understand cancer on a more 'intimate' basis--its biochemical or metabolic underpinnings--a "transforming discovery" in this disease is not likely to occur.

When we can finally turn our attention to the reality that even though it is the "tumor" that kills, it is in an understanding of those processes that lead up to tumor formation--its metabolic and biochemical fundamentals--that the war on cancer will truly be won.