Health Advice: Why Is Our Progress Against Cancer So Slow?

Sometimes it seems like we're not making much headway against cancer. Are we?

Samuel Broder, MD: The answer is clearly yes, but with qualifications.

Video: Cancer Treatments

First, the good news. According to the statistics published by the National Cancer Institute, the Centers for Disease Prevention and Control, and the American Cancer Society, the death rates from all cancers combined have decreased in both men and women and in most racial and ethnic groups. These advances were primarily driven by reductions in the death rates for the three most common forms of cancer in men (lung, colon, and prostate) and for two of the three key forms of cancer in women (breast and colon), coupled with a plateau of lung cancer deaths in women.

Taken together, cancer death rates in the middle of this decade decreased by more than 18 percent among men and nearly 11 percent among women, compared with the statistics in the early '90s. More than a half-million deaths from cancer were avoided during these time intervals because of advances in prevention, early detection and diagnosis, and treatment. Younger adult age groups have experienced the most notable progress. And for certain childhood cancers (like acute lymphoblastic leukemia) or certain cancers that target younger adults (such as testicular cancer), the progress has been very substantial by any measure.

There has been considerable progress in using adjuvant chemotherapy, or treatment given after surgery before detectable spread of cancer cells to distant sites, to prevent relapses. There have also been advances in minimally invasive surgery and in the field of radiotherapy. For instance, there has been progress in "3D" radiation treatment planning to match the spatial distribution of the radiation dose to the shape of the tumor, and also in internal radiation treatment, called brachytherapy, in which radioactive sources are inserted into cancers. These advances spare normal anatomy and improve the lives of cancer survivors.

Indeed, some critics of the nation's cancer programs have now revised longstanding sentiments of pessimism or even futility. For example, John Bailar who famously coauthored a scientific review in the late 1990s entitled "Cancer Undefeated," was recently quoted in the Wall Street Journal as saying, "My general sense is that mortality rates for cancer are going down. There's no doubt about it, and that's very good news."

But much unfinished business remains. Cancer, particularly when it is in an advanced or metastatic state, remains a formidable challenge. We have made enormous progress in understanding the molecular biology of cancer and developing molecular diagnostics to get the right drugs to the right patients—-what is sometimes called personalized medicine—-but for certain tumors, we still do not know how to translate this knowledge into curative treatments.

And even when there is a clear road map to reducing death rates, the path may be strewn with obstacles. For example, smoking represents one of the most important causes of cancer, especially lung cancer. Nevertheless, it is still widespread. Indeed, lung cancer death rates among women have actually increased in many states, most notably in the South or Midwest, where the percentage of women who smoke remains unfavorable and thereby prefigures a future "harvest" of lung cancers and other smoking-related illnesses. All of this is incredibly tragic because lung cancer was once a comparatively rare disease, and there is no fundamental reason why it could not become so again. Alton Ochsner, a surgeon who helped identify tobacco as the major cause of lung cancer, is quoted as follows: "When I was a medical student at Washington University in 1919, a patient died of lung cancer. Our professor called us all in to see the autopsy. He said this condition was so rare we might never see another one." Imagine: In 1919, lung cancer was felt to be so rare a professor predicted that his medical students might never see another case.

Here are a number of steps I think we should be taking to build on the gains already made and to intensify efforts where progress has been more difficult: