172Health Administrator Vol: XVII, Number 1: 172-183,pg.WHY ARE WE LOSING THE WAR ON CANCER(AND HOW TO WIN IT)*Clifton LeafAvastin, Erbitux, Gleevec... The new wonder drugs might make you think we’re finally beatingthis dreaded scourge. We’re not. Here’s how to turn the fight around.The question may come as a shock to anyonewho has witnessed a loved one survive the dreaddisease-or marveled at Lance Armstrong powering tohis fifth Tour de France victory after beating backtesticular cancer, or received a fundraising lettersaying that a cure is within our grasp. Most recently,with media reports celebrating such revolutionarycancer medicines as Gleevec, Herceptin, Iressa,Erbitux, and the just-approved Avastin, the cure hasseemed closer than ever.But it’s not. Hope and optimism, so essential tothis fight, have masked some very real systemicproblems that have made this complex, elusive,relentless foe even harder to defeat. The result is thatwhile there have been substantial achievements sincethe crusade began with the National Cancer Act in1971, we are far from winning the war. So far away,in fact, that it looks like losing.Just count the bodies on the battlefield. In 2004,cancer will claim some 563,700 of your family, friends,co-workers, and countrymen. More Americans will dieof cancer in the next 14 months than have perished inevery war the nation has ever fought ... combined. Evenas research and treatment efforts have intensified overthe past three decades and funding has soareddramatically, the annual death toll has risen 73% -over one and a half times as fast as the growth of theU.S. population.Within the next decade, cancer is likely toreplace heart disease as the leading cause of U.S.deaths, according to forecasts by the NCI and theCenters for Disease Control and Prevention. It isalready the biggest killer of those under 75. Amongthose ages 45 to 64, cancer is responsible for moredeaths that the next three causes (heart disease,accidents, and stroke) put together. It is also theleading disease killer of children, thirty somethings -and everyone in between.Researchers point out that people live a lotlonger than they used to, and since cancer becomes*Fortune, March 29, 2004/ No. 5It’s strange to think that I can still rememberthe smell after all this time. The year was 1978, notlong after my 15th birthday, and I’d sneaked into mybrother’s bedroom. There, on a wall of shelves thatstretched to the ceiling, were the heaviest books wehad in our house - 24 volumes of the EncyclopediaBritannica. The maroon spines were coated in a filmof dust, I remember. The pages smelled as if a mustyold pillow had been covered in mint.I carefully pulled out the volume markedHALICARNASSUS TO IMMINGHAM and turned tothe entry for Hodgkin’s disease. It took forever to readthe half-dozen paragraphs, the weighty book spreadopen on my lap like a Bible. There was talk of amysterious “lymphatic system,” of “granulomas” and“gamma rays”, as though this disease - the one thedoctor had just told me I had - was something out ofscience fiction. But the last line I understood all toowell: Seventy-five percent of the people who got itwould die within five years.As it turns out, I did not die from Hodgkin’s,though the cancer had already spread from my neck tomy lungs and spleen. I lost my spleen to surgery andmost of my hair to chemotherapy and radiation. But Iwas lucky enough to get into a clinical trail at theNational Cancer Institute that was testing a newcombination therapy - four toxic chemicals, togethercalled MOPP, plus those invisible gamma rays, whichflowed from an enormous cobalt 60 machine threestories below ground. The nurses who stuck needlesin my arm were so kind I fell in love with them. Thebrilliant doctor who tattooed the borders of animaginary box on my chest, then zapped me withradiation for four weeks, had warm pudgy hands anda comic look of inspiration, as though he’d thought ofsomething funny just before entering the exam room.The American taxpayer even footed the bill.Most of all, of course, I was lucky to survive. Soit makes the question I am about to ask soundparticularly ungrateful: Why have we made so littleprogress in the War on Cancer?173more prevalent with age, it’s unfair to look just at theraw numbers when assessing progress. So when theycalculate the mortality rate, they adjust it to comparecancer fatalities by age group over time. But evenusing this analysis (in which the proportion of elderlyis dialed back to what it was during the Nixonadministration), the percentage of Americans dyingfrom cancer is about the same as in 1970 ...and in 1950.The figures are all the more jarring when comparedwith those for heart disease and stroke-other ailmentsthat strike mostly older Americans. Age-adjusteddeath rates for those diseases have been slashed byan extraordinary 59% and 69%, respectively, duringthe same half-century.Researchers also say more people are survivinglonger with cancer than ever. Yet here, too, thecomplete picture is more disappointing. Survival gainsfor the more common forms of cancer are measured inadditional months of life, not years. The few dramaticincreases in cure rates and patient longevity have comein a handful of less common malignancies - includingHodgkin’s, some leukemias, carcinomas of the thyroidand testes, and most childhood cancers (It’s worthnothing that many of these successes came in the earlydays of the War on Cancer). Thirty-three years ago,fully half of cancer patients survived five years or moreafter diagnosis. The figure has crept up to about 63%today.Yet very little of this modest gain is the resultof exciting new compounds discovered by the NCI labsor the big cancer research centers - where nearly allthe public’s money goes. Instead, simple behavioralchanges such as quitting smoking have helped lowerthe incidence of deadly lung cancer. More important,with the help of breast self-exams and mammography,PSA tests for prostate cancer, and other testing, we’recatching more tumors earlier. Ruth Etzioni, abiostatistician at Seattle’s Fred Hutchinson CancerResearch Center, points out that when you break downthe Big Four cancers (lung, colon and rectal, breast,and prostate) by stage - that is, how far the malignantcells have spread - long-term survival for advancedcancer has barely budged since the 1970s.And the new cases keep coming. Even with adip in the mid-1990s, the incidence
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