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An Ounce of Prevention

Billions are spent on finding cures, little on keeping cancer from occurring

By Samuel S. Epstein and Quentin D. Young
Dr. Samuel S. Epstein is chairman of the Cancer Prevention Coalition and professor emeritus at the University of Illinois at Chicago School of Public Health. Dr. Quentin D. Young is chairman of the He

August 31, 2003

CHICAGO — In 1971, after well-orchestrated appeals from representatives of the National Cancer Institute and from the world's wealthiest nonprofit, the American Cancer Society, Congress passed the National Cancer Act, which authorized a national cancer program. President Nixon quickly announced his "War Against Cancer," and the country was off and running.

Since then, we've been repeatedly assured that breakthroughs are imminent. In 1984, the NCI promised that cancer mortality would be halved by 2000. In 1998, we were assured by both the NCI and the American Cancer Society that the nation had "turned the corner" in the war. Just this year, NCI Director Andrew von Eschenbach pledged to "eliminate the suffering and death from cancer by 2015."

But after spending 30 years and some $50 billion, we are further from winning this war than when it was first declared. A recent government analysis of leading causes of mortality in the U.S. from 1973 to 1999 revealed that, although the percentage of the population dying from heart disease decreased by 21 percentage points during the period, cancer deaths increased by 30 percentage points. Some 1.3 million Americans are found to have cancer each year, and more than half a million die from it.

Paradoxically, it seems that the more we spend on cancer research, the more cancer we get. The steep rise in disease comes alongside a far steeper rise in the NCI's budget, which has shot up from $150 million in 1970 to its current $4.6 billion. Today, more than 40% of men and more than 1 in 3 women develop cancer during their lifetimes. Cancer has become a "disease of mass destruction." Incidences of breast, testicular, thyroid and lymph gland cancers have all risen sharply, as have cancer rates in African Americans and in children.

So how can we be spending more and still be losing ground? Because the cancer establishment's focus remains fixated on damage control — screening, diagnosis, treatment and related basic research — rather than on preventing cancer in the first place. The things on which we're spending money are important and fully deserve substantial funding. But much less spending on cures would be needed if more cancers were prevented.

One of the few successes in the cancer war has been a sharp decline in lung cancer cases as people have either quit smoking or not taken up the habit. This is a case where prevention has clearly worked. But still, only minimal funding is provided for prevention research, and what there is gets spent mostly on research into smoking and poor diet. U.S. Rep. John Conyers Jr. (D-Mich.), ranking minority member of the House Judiciary Committee, recently warned that, although much of cancer's carnage is preventable, it would be prevented only "if the NCI gets off the dime and does its job." In the meantime, far too little is being spent on research into avoidable causes of cancer, including environmental contaminants of air, water, soil, the workplace and food.

Not nearly enough research is being done into carcinogenic ingredients in cosmetics, toiletries and household products, particularly pesticides and prescription drugs. The failure of the cancer establishment to aggressively investigate avoidable causes of cancer has discouraged legislative and regulatory actions to protect people from carcinogens and encouraged petrochemical and other industries to continue manufacturing potentially carcinogenic products.

It wasn't supposed to be this way. The National Cancer Act called for "an expanded and intensified research program for the prevention of cancer caused by occupational or environmental exposure to carcinogens." But the cancer establishment has not only failed to embrace that mission; it has suppressed evidence of causation that it had in its possession.

Take the NCI's belated release, in 1997, of long-standing evidence predicting up to 210,000 thyroid cancers from exposure to radioactive fallout following atomic bomb tests in Nevada in the 1950s. These cancers could have been prevented by thyroid medication had the NCI warned the public in time. The Senate Committee on Governmental Affairs, in a 1999 hearing, charged that the NCI investigation was "plagued by lack of public participation and openness" and characterized the NCI's failure to release this information to the public in a timely fashion as "a travesty."

The NCI's apparent lack of interest in prevention is institutionally embedded. Benno C. Schmidt, the first chairman of President Nixon's three-member NCI executive cancer panel, was an investment banker and senior drug company executive with close ties to the oil, steel and chemical industries. He was followed in the 1980s by Armand Hammer, the late oil magnate and chairman of Occidental Petroleum, one of the nation's largest makers of industrial chemicals. Not surprisingly, Schmidt and Hammer showed little interest in cancer prevention and instead focused almost exclusively on highly profitable drug development and marketing.

The American Cancer Society's financial ties to manufacturers of polluting chemicals and cancer drugs are also extensive. More than 25 drug and biotech companies — including Bristol-Myers Squibb, Pfizer, AstraZeneca, Eli Lilly, Amgen, Genentech and Johnson & Johnson — contribute more than $100,000 apiece annually to the group. It also receives substantial support from British Petroleum, DuPont, Akzo Nobel, Pennzoil and Concho Oil.

The American Cancer Society's strong support from industry is reflected in its research choices, which are overwhelmingly aimed at treatment. As the Chronicle of Philanthropy, the nation's leading charity watchdog, put it in a January 1992 article, "The ACS is more interested in accumulating wealth than saving lives." The NCI's prevention budget is, at first glance, less parsimonious. The agency's 2001 publication "Cancer Facts" noted that "cancer prevention is a major component and current priority — to reduce suffering and death from cancer." This was followed by the claim that 12% of its budget is allocated to prevention. But the only prevention efforts mentioned had to do with tobacco and poor diet. No reference was made to environmental and occupational carcinogens.

The war on cancer is certainly winnable. But we've spent many years and billions of dollars focusing on cures. Focusing on prevention instead would not only save lives: It would save dollars.