The THIRTY YEARS war on cancer, Daniel DiMaio, M.D., Ph.D.
As published in The Hartford Courant on September 27, 2007
For Immediate Release
Date: 9/27/07
Contact: Renee Gaudette, (203) 436-8533 or renee.gaudette@yale.edu
More than thirty years ago, the National Cancer Institute declared War on Cancer. How is the war going? The forecasts of an easy fight and an early victory were wildly optimistic, but there have been some stunning successes. We have learned how to manipulate and study cells and DNA, resulting in a rich, if still incomplete, understanding of the molecular and cellular basis of cancer. We have discovered the genes that cause cells to become cancers, and we have uncovered the biochemical pathways controlled by these genes. We have identified environmental carcinogens and behaviors that increase our cancer risk, and we have discovered viral and bacterial causes of cancer. Recent years have seen the development of highly effective and specific drugs that attack the molecular machinery of cancer, such as Herceptin for breast cancer and Gleevec for some forms of leukemia and other cancers. In some cases, the most effective treatment can even be predicted by genetic analysis of a patient’s tumor. Improvements in technology allow the diagnosis of cancer at progressively earlier and more treatable stages, resulting in improved survival. Successful vaccination and antibiotic treatment strategies have been instituted that prevent cancers caused by certain infectious agents. For the first time, rates of cancer mortality in the United States are dropping.
Despite these evident successes, progress has not been rapid and the war is not yet won. We are fighting against strong demographic currents. Cancer predominantly strikes older people, and more and more people are surviving into the years of peak cancer risk as the population ages due to the prevention of premature deaths from various other causes. The epidemic of obesity and the continuing scourge of tobacco use also hinder efforts to prevent cancer. There are also many different types of cancer, and preventive measures and treatments that are effective against one type are often ineffective against another. Fortunately, despite this complexity, there are some principles that apply to a broad array of cancers, and molecular studies reveal that the same pathways are aberrant in many different cancers. These findings suggest that we are on the verge of developing general strategies that may form the basis of effective approaches for the prevention and treatment of many types of cancer.
So where are we in the War on Cancer? We are closer to Normandy than we are to Pearl Harbor. The early defeats are behind us, we have identified the vulnerabilities of our enemies, we have mobilized and armed a great force and are developing a winning strategy, and final victory is within grasp. It is thus surprising and disheartening that Congress is considering a paltry 1.5% increase in the budget for the National Cancer Institute, which funds the vast majority of cancer research in the United States. This budget proposal does not even keep up with inflation and is thus, in effect, a reduction in funding. This level of funding would represent a major set-back in the battle against cancer, one that will prolong the war.
The price of poor funding is steep and already evident in the trenches of cancer research. Our top students are exploring other careers. Promising young faculty cannot get their research programs off the ground. Successful mid-level faculty need to rewrite and submit strong grants multiple times before they are funded, an inefficient system that wastes time and delays progress. Senior professors are contemplating early retirement because it is difficult to maintain a well-funded research effort. These trends will only accelerate if the proposed budget is adopted, and they cannot be rapidly reversed. It takes years to assemble strong and productive research teams, but these teams rapidly dissolve as research funding tightens and will take years again to reassemble when the battle is rejoined in the future. In this environment, will promising ideas and studies languish? Yes. Will new treatments, diagnostic tests, and preventive measures be delayed? Without a doubt. Will cancer patients and their families pay the price? Of course they will.
We are winning the War on Cancer, but we cannot coast to victory. Inevitably, there will be wrong turns, dead ends, unjustified despair, unrealistic predictions, and premature declarations of victory. Final success will require the hard work and dedication of scientists and clinicians and the strength and optimism of patients, and it will be marked not by unconditional surrender but by the grudging retreat of cancer to the list of diseases that can be prevented, successfully treated, and often cured. This success depends on robust and predictable funding from the federal government, to consolidate the gains we have made and to press the fight forward.
Dr. DiMaio is the Waldemar Van Zedtwitz Professor of Genetics and Professor of Therapeutic Radiology at the Yale University School of Medicine and Scientific Director of Yale Cancer Center.