Through an analysis of over 40 years of medical evidence and interviews with cancer doctors, researchers, drug company executives, and health policy advisors, Dr. Cuomo reveals frank and intriguing answers to these questions. In A World without Cancer: The Making of a New Cure and the Real Promise of Prevention, she shows us how all cancer stakeholders—the pharmaceutical industry, government, physicians, and concerned Americans—can change the way we view and fight cancer in this country.
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About the Author
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HONORING A COMMITMENT
MY FRIEND ROSEMARY WAS 48 WHEN SHE WAS diagnosed with breast cancer. The mother of six children, she was the epicenter of her family, its inspiration and its "glue." She was a partner in every sense to her husband, a well-known author and journalist. Both were passionate New Yorkers, and together they traveled the city's neighborhoods and met some of its greatest characters.
After her diagnosis, Rosemary sought out the most promising treatments from the best minds in medicine. Although the treatments were grueling, she was rarely preoccupied by her own pain and never lost interest in what her friends and family were doing. A woman of remarkable grace and dignity, she maintained a generosity of spirit and usually found something uplifting to say to everyone around her.
I recall vividly my visit to Rosemary's hospital bed on the day I graduated from medical school. She was a patient at Lenox Hill Hospital in New York City, weakened by chemotherapy and swollen from steroid treatments, but when I walked into her room, she immediately focused on me. I had come straight from my graduation ceremony, still wearing my new pink chiffon dress. "It's elegant and simple, just right for this occasion," she told me, as if nothing else could possibly matter more to her right then.
Over the next few weeks, I visited Rosemary several times. The illness had her more and more in its grip, and I was soon doing most of the talking-- primarily about growing up with four siblings in the working-class borough of Queens. Rosemary had raised her family there too and was comforted by my stories of familiar people and places.
We could still laugh together, and sometimes we would cry together. She reminded me that little matters as much as the love and support that family and friends can offer.
Still, I was a newly minted doctor, enthusiastic about the great medical advances of Western medicine. I thought surely there should be a therapy or a procedure that could put an end to cancer's ravaging assault. Sadly, I had nothing to suggest.
Rosemary died at the age of 52, with her husband, family, and close friends gathered at her hospital bedside. "She took half my typewriter with her," said her husband at the memorial service. It was an overwhelming, devastating loss, and a sense of hopelessness filled each of us who cared deeply about her.
I was not alone in feeling that I had somehow failed Rosemary. Her husband described the incapacitating experience. "Cancer seeps into your nervous system," he said. "Not the disease itself, but the horror of it."
The distress we shared was fueled, at least in part, by disillusionment. What progress have we made since 1971, when our government promised to wage a war that would end in a cure for cancer? Why are we still in a quagmire, without victory in sight? How can it be that in the United States, one out of every two men, and one out of every three women, will develop some form of cancer during their lifetimes? Isn't there something we can do to prevent cancer's relentless march?
In his 1971 State of the Union address, President Richard M. Nixon promised Americans that he would begin "an extensive campaign to find a cure for cancer" and that, in addition to requesting $100 million for that purpose, he would "ask for whatever additional funds can effectively be used." He added: "The time has come in America when the same kind of concentrated effort that split the atom and took man to the moon should be turned toward conquering this dread disease. Let us make a total national commitment to achieve this goal."1
The idea made perfect sense. Many experts were confident that if the government marshaled its resources and focused its efforts, we could end the horror of cancer.
After all, the 20th century was the American century, when we could accomplish the unimaginable. Nixon drew resonant parallels. Everyone knew about the extraordinary results of the Manhattan Project, the top-secret research effort that began in 1936 and eventually brought together 130,000 people at 30 sites to develop the most powerful weapon the world had ever seen.
Another outstanding achievement was the first manned flight to the moon. In May 1961, President John F. Kennedy launched the space race in earnest, going before Congress to announce the goal of landing an American on the lunar surface by the end of the decade. We go to the moon, he said in a speech at Rice University the following year, not because it is easy but because it is hard. "That challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win."2 In July 1969, American Neil Armstrong took that "one small step for man, one giant leap for mankind."
It showed what teamwork and a sense of urgency could do.
Eradicating cancer was the next logical mission. The disease was taking a terrible toll--although back then we weren't counting cases very rigorously, so no one can be sure just how many people heard those searing words "I'm sorry, you have cancer." By our best estimates, some 650,000 Americans were expected to get that bleak diagnosis in 1972. Two out of every three American families would be affected that year.3
We had made so many strides in so many areas of medicine earlier that century, discovering antibiotics to cure infections and vaccines to curb viruses. Surely, ending cancer would be no more difficult.
Our confidence was buoyed by our increased understanding of the links between behavior and disease. Smoking had been established as a cause of lung cancer, raising the possibility that other clear cause-and-effect pathways could be identified.
Treatments were improving at the same time. Nearly two in five people who had received a cancer diagnosis were alive five years later, an impressive improvement over the 1930s, when fewer than one in five lasted that long. Promising new therapies for some cancers were on the market, and others were in the pipeline. Thanks to novel chemotherapy regimens, the three-year survival rate for acute lymphocytic leukemia, a common childhood cancer, had risen from 2 to 15 percent from the early 1960s to the early 1970s. During that same period, the five-year survival rate for Hodgkin's disease had jumped from 44 to 61 percent.4
It was time to turn that kind of progress into full-fledged victory. We were moving past some of the research disappointments of the 1950s, when "talk of curing cancer with drugs was not considered compatible with sanity," according to Vincent T. DeVita Jr., MD, a former director of the National Cancer Institute (NCI).5 Optimism was in the air.
MARY LASKER AND THE BIRTH OF HOPE
Mary Woodard Lasker, a Wisconsin native born in 1900, had a lot to do with kindling a sense of possibility. Jonas Salk, who gave us the world's first polio vaccine, called her "a matchmaker between science and society." 6
When Lasker first turned her attention to cancer, it was a shameful disease. "Cancer was a word you simply could not say out loud," she recalled. In the 1940s, the family's long-term housekeeper was diagnosed with breast cancer and had both breasts surgically removed. She stoically refused to tell anyone what had happened. That was a watershed moment for Lasker, setting her on a course to change the trajectory of the disease and how we respond to it.
"I am opposed to heart attacks and cancer and strokes the way I am opposed to sin," she declared.
Mary Woodard Lasker was persuasive and passionate in her own right, and her marriage to Albert Lasker forever changed the medical landscape. As president of an advertising firm that marketed iconic American products, including Lucky Strike cigarettes, Pepsodent toothpaste, and Sunkist oranges, he was a man who knew something about the art of selling an idea.
Together, the couple created a powerful lobby that led to huge increases in federal funding for medical research. Mary Lasker's philosophy was pragmatic. "You can solve any problem if you have money, people, and equipment," she declared. Thanks in significant measure to her advocacy, the budget for the National Institutes of Health, the nation's premier research enterprise, increased from just over $3 million to nearly $1 billion in the two decades following World War II.
When the Laskers applied their considerable charm, connections, and business acumen to the American Society for the Control of Cancer, they transformed that institution too. In the early 1940s, it had just 1,000 members, and an annual budget that barely topped $100,000, none of it allocated to research. By 1948, they had taken control of the board, renamed it the American Cancer Society (ACS), and put $14 million into its coffers through aggressive fund-raising; 25 percent of those funds were dedicated to research. ACS became an enormously important platform for publicizing cancer and attracting still more funding to combat the disease.
Thanks to the marketing skills of the Laskers, cancer began receiving more coverage in mainstream publications and on the radio, which back then was the news and information mainstay of the American family. It was a time of new openness, a form of "coming out" that changed the national conversation.
With a wave of interest behind them, Mary Lasker and her ACS colleagues lobbied Congress to increase funding for the National Cancer Institute (NCI). Federal appropriations jumped from $1.75 million in 1946 to more than $14 million the following year.
The cancer diagnosis of her husband, who died in 1952, added urgency to Lasker's crusade. She found common cause with cancer researcher Sidney Farber, MD, the Boston pathologist who has been called the father of modern chemotherapy. In 1947, Dr. Farber was the first to effectively use aminopterin (which had been discovered by Yellapragada Subbarao, MD) to achieve temporary remissions in children with acute lymphocytic leukemia. The Dana-Farber Cancer Institute, in Boston, one of the nation's leading cancer centers, bears his name.
Convinced that cancer could be cured, Lasker and Farber continued their push for more research dollars, and federal allocations kept growing. By 1961, the NCI had a budget of $110 million.
However, the federal government's commitment was not nearly enough to satisfy Lasker. By the late 1960s, she was calling for a "war on cancer."
She and her allies founded the Citizens Committee for the Conquest of Cancer, which placed a full-page advertisement in the Washington Post and the New York Times in 1969 that announced, "MR. NIXON: YOU CAN CURE CANCER." The ad also included a quotation from Dr. Sidney Farber: "We are so close to a cure for cancer. We lack only the will and the kind of money and comprehensive planning that went into putting a man on the moon." That remarkable achievement had occurred just five months earlier.
In 1971, Congress held a subcommittee hearing on the National Cancer Act at the Roswell Park Cancer Institute in Buffalo, New York, which had been founded in 1898 as the nation's first cancer center.7 Representative Jack Kemp of New York put cancer's toll on Americans in stark perspective when he said that the disease had killed eight times as many citizens in a single year (1970) than had died in the previous six years of the Vietnam War. Cancer was the nation's second leading cause of death, after heart disease, and remains so today.
Despite that chilling statistic, witnesses at the hearings were generally determined and optimistic. Scientists spoke enthusiastically about the possibility of conquering cancer. David Pressman, MD, associate director for scientific affairs at Roswell, emphasized that while surgery, radiation, and chemotherapy could be used to manage cancer, the "ultimate goal of all cancer research is the prevention and elimination of disease."8
There were vigorous discussions about how much progress was possible until we could answer some very fundamental questions about how cancer spreads. One school of thought was that more knowledge about basic science--for example, about the molecular mechanisms that cause cells to thrive, reproduce, and die--had to come first. Others reasoned that it was not always necessary to fully understand a disease in order to eliminate it. Dr. Pressman fell into the latter camp.
"We have several different causes of cancer. We know carcinogenic substances can produce cancer. We know viruses can produce cancer. We are working on mechanisms for this, but the question of continuing basic research is not a problem," he said.
Dr. Pressman saw basic science and applied know-how advancing together, with each informing the other. "In the space program, the effect of weightlessness on man is still unknown, but that didn't stop us from going ahead and putting a man on the moon."9
Thanks in large part to Mary Lasker's advocacy, Congress passed the National Cancer Act of 1971. Two days before Christmas, President Nixon signed it into law, declaring, "I hope in the years ahead we will look back on this action today as the most significant action taken during my administration."
Under the legislation, a record-breaking $1.59 billion became available for cancer research over the next three years. A number of other important provisions, which remain in place to this day, stand as testimony to the unique stature of cancer research. The director of the NCI is appointed by the president, rather than by the director of the National Institutes of Health, as is the case at most federal biomedical research institutes. Likewise, the NCI's budget requests are submitted directly to the White House. These factors gave the NCI an unprecedented degree of autonomy and spared it from competing with other scientific agencies to get the largest possible slice of the federal research pie.
At that time, it all seemed very promising. Lasker and her allies hoped that a combination of commitment, resources, scientific talent, and enthusiasm would combine to transform the culture of cancer research. Unfortunately, she did not live to see cancer eradicated. In 1994, her vigorous 94 years of life came to an end due to natural causes. Her hopes for a cure remain unfulfilled.
More than 40 years after the war on cancer was declared, we know much more about the disease than we once did, but we are not much closer to preventing it. The NCI has spent some $90 billion on research and treatment during that time.10 Some 260 nonprofit organizations in the United States have dedicated themselves to cancer--more than the number established for heart disease, AIDS, Alzheimer's disease, and stroke combined, according to the Journal of Clinical Oncology. Together, these 260 organizations have budgets that top $2.2 billion. 11
Yet from 1975 to 2007, breast cancer rates increased by one-third and prostate cancer rates soared by 50 percent. Widespread screening with mammography and the prostate-specific antigen (PSA) test played a significant role in detecting these cases, making direct comparisons difficult. Still, we clearly have a problem. Almost 1.6 million people were diagnosed with cancer in 2011.12 When have Americans ever waged such a long, drawn-out, and costly war, with no end in sight?
Table of Contents
Introduction: Pushed Against the Wall vii
Chapter 1 Honoring a Commitment 1
Chapter 2 Understanding Cancer 20
Chapter 3 The Promise and Limits of Cancer Screening 36
Chapter 4 Cut, Poison, and Burn: A Look at Today's Treatment Options 56
Chapter 5 What the Market Will Bear 80
Chapter 6 Paying More, Settling for Less 96
Chapter 7 Cancer's Collateral Damage 112
Chapter 8 Shifting the Research Approach 126
Chapter 9 The Promise of Prevention 150
Chapter 10 Cancer-Proofing the Environment 167
Chapter 11 Ending the Scourge of Tobacco 180
Chapter 12 Fighting Cancer with Nutrition and Physical Activity 193
Chapter 13 The Power of Vitamin D 211
Chapter 14 Can Pills Prevent Cancer? 222
Chapter 15 On the Cutting Edge of Science 228
The Final Word: From Imagination to Transformation 244
List of Expert Interviews 272
Most Helpful Customer Reviews
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