Yesterday I received a sad email. A friend was just diagnosed with progressive supranuclear palsy, a rapidly degenerative neurologic disorder for which there is no treatment.
I know the disease well, because it took the life of my dearest friend. During her difficult journey, my friend lost her mental faculties, and her progressive weakness was eventually so profound that she could not eat or even handle her own secretions. My beautiful, creative friend was reduced to a mere shadow of herself. I could only take comfort in the fact that she died without pain.
Ironically, when the message came to me yesterday, I was in clinic telling some patients that I had nothing more to offer them. Having no treatment for a fatal disease made me reflect on our “war against cancer,” including where progress has been made and where it has not. Having had several decades to study this as an academic oncologist, I have had the privilege of seeing many battles won and the pain of seeing many battles lost.
In 1971, President Richard Nixon declared “war on cancer” and signed the National Cancer Act, which established the NCI, created a clinical trial infrastructure across the country, and established funding for peer-reviewed research.1 Still, for a long time, cancer care providers struggled. Our impact was modest in many malignancies, and we completely failed in some, such as lung cancer, in which the incidence and mortality continued to rise. Declining mortality in colorectal, uterine, and stomach cancers actually began before the law was signed. The public seemed unsettled that little progress was being made, and we were even publicly criticized for “losing the war.”
Then, around 1990, things began to change. Mortality began to decline in breast, prostate, and lung cancers, and the decline has been steady and continuous since. The reasons for these declines vary by disease, of course. In lung cancer, the declines were primarily driven by tobacco control and early detection. In recent years, improved therapy is contributing too. I have attributed most of the mortality decline in breast cancer to improvements in therapy, but I haven’t figured it out for prostate cancer! I think both screening and treatment contribute, but of course, screening remains controversial. The continued decline in deaths from colorectal cancer is most surely due to early detection and polyp management.
In the future, we will probably see lower incidence rates (and therefore mortality) in HPV-related malignancies such as cervical cancer, especially if there is wider adoption of the HPV vaccine. But we are not winning every battle. Although viral-related liver cancer is less common with prevalent use of antiviral therapy, liver cancer secondary to more common nonalcoholic steatohepatitis is on the rise. Other very lethal cancers, such as pancreatic adenocarcinoma, are also showing a disturbing rise in incidence.
Although we clearly still have work to do, our nation’s investment in cancer research is paying off. And I hope, someday, that kind of success is realized across the full spectrum of diseases for which there is “no treatment.” If we can beat cancer, we can beat anything!
National Cancer Institute. National Cancer Act of 1971. Accessed September 10, 2022. Available at: https://www.cancer.gov/about-nci/overview/history/national-cancer-act-1971
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MARGARET TEMPERO, MD
Margaret Tempero, MD, is a Professor of Medicine and Director of the UCSF Pancreas Center and editor-in-chief of JNCCN. Her research career has focused on pancreatic ductal adenocarcinoma, especially in the area of investigational therapeutics. Dr. Tempero has served on the ASCO Board of Directors and as ASCO President. She currently serves on the ASCO Conquer Cancer Foundation Board. She codirected the AACR/ASCO Methods in Clinical Cancer Research and taught this course and similar courses in Europe and Australia. She was founding Chair of the NCI Clinical Oncology Study Section and served as a member and Chair of the NCI Board of Scientific Counselors Subcommittee A. She is a member of the Scientific Steering Committee and Chair of the Clinical and Translational Study Section for the Cancer Prevention & Research Institute of Texas. She is or has been on the Scientific Advisory Boards of the Lustgarten Foundation, the Pancreatic Cancer Action Network, the V Foundation, The Alberta Canada Cancer Board, and the EORTC. She served as a member of the Oncology Drug Advisory Committee for the FDA. She has served as Deputy Director and Interim Director for the UNMC Eppley Cancer Center. She is Chief Emeritus of the Division of Medical Oncology at UCSF. She served as the founding Deputy Director and was later Director of Research Programs at the UCSF Helen Diller Family Comprehensive Cancer Center.