A quick war-on-cancer FAQ

Why focus on cancer instead of a bigger killer, heart disease? And how could taxpayer money be spent to fix the mess?

Published October 12, 2004 7:30PM (EDT)

Recent reports about the "war on cancer" have generally been upbeat, and medical science is said to be making gains on the disease. If this system isn't broken, why fix it?

Optimistic reports refer to gains made on cancer deaths in the past decade, about 1 percent per year since the peak of cancer mortality in 1991. If tracked more longitudinally by age-adjusted data -- statistics that compensate for today's older American population -- the war could be called a draw.

For example, in 1950 cancer killed 193.9 out of every 100,000 Americans. In 2001, it killed 195.6 out of every 100,000, according to the latest age-adjusted analysis of statistics published by the American Cancer Society. In 1971, when Congress declared its war on the disease, cancer was killing 198.9 out of every 100,000 Americans, according to age-adjusted data from the national Centers for Disease Control and Prevention. At its peak in 1991, cancer killed 215.1 out of every 100,000 Americans. Epidemiologist Dr. Ahmedin Jemal, of the American Cancer Society, said elements tied to the evolving 20th century American lifestyle -- such as tobacco smoking and increased obesity -- partially explain why the war waxed and waned. A reason frequently cited for the incremental decreases in cancer mortality during the past decade has nothing to do with science. More Americans quit smoking.

Heart disease is the No. 1 killer in the United States. Why should Congress focus its attention -- and funding -- on cancer?

Deaths from cardiovascular diseases have been decreasing far more rapidly than those from cancer because of increased public education about the effects of diet and lifestyle on things such as cholesterol and blood pressure. "Cancer" is an umbrella term used to describe what scientists say is an unknown number of malignant-cell diseases, perhaps hundreds or even thousands. Simply, cancer is a more formidable foe that strikes one in two U.S. men and one in three U.S. women.

In 1950, cardiovascular diseases killed 586.8 out of every 100,000 Americans. By 2001, the rate had fallen to 245.8 for every 100,000, according to the latest CDC statistical analysis. At these present rates, someday within the next decade or two cancer will replace heart disease as the No. 1 killer, unless "the cancer war escalates or there is a silver bullet or something," Jemal said. He is currently working on the U.S. projections for when the switch will likely occur. This spring the Canadian Cancer Society projected that cancer would be its No. 1 killer by 2010.

How does cancer death in the United States compare to the rest of the world?

Cancer results in about 6 million deaths every year, or 12 percent of deaths worldwide, according to the World Health Organization. The rate of cancer death in 2000 in the United States ranked somewhere in the middle -- near Canada and New Zealand -- of the 45 nations tracked by WHO. The Indian Ocean island democracy of Mauritius (pop. 1.2 million) ranks tops; its rate is about half the U.S. rate. Hungary, a European population notorious for its love of cigarettes, ranks worst.

How would more taxpayer money benefit medical science's war on cancer?

The profit motives of industry and Wall Street do not always complement humanitarian science. For example, because of the competitive nature of business, much of the drug industry ignores a federal law requiring medical studies to be listed on an important government database. The Food and Drug Administration reported this summer that fewer than half the industry-funded studies for cancer drugs were being posted.

There is no penalty attached to the law, and companies are reluctant to reveal information they consider intellectual property, says Dr. Richard Pazdur, the FDA's director of oncology drugs. The Web site primarily is intended for use by doctors and patients searching for suitable drug trials.

There is also a dearth of patients for the clinical trials of cancer drugs. Fewer than 5 percent of American cancer patients participate, Pazdur says. Similarly, corporate competition is so keen that the drug companies OSI Pharmaceuticals and AstraZeneca ran opposing trials last year on nearly identical cancer drugs. The redundancy consumed vast resources and 4,000 trial patients. "To have two companies working on similar particles in this competitive fashion is perhaps not in the best interest of the cancer patient," Pazdur says. If the National Cancer Institute, the government's principal financier of oncology research, held more of the purse strings, doctors such as Pazdur believe barriers to collaboration would fall. The NCI began this spring requiring scientists, universities and industries that use its money to sign collaborative agreements.

By Greg Barrett

Greg Barrett is a national correspondent for Gannett News Service based in the GNS/USA Today bureau in Washington, D.C.

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