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Is the “war on cancer” winnable? 40 years after the unofficial declaration, the disease is spreading throughout the globe

The views expressed are those of the author and are not necessarily those of Scientific American.


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cancer cell war on cancer is 40Pervasive, elusive and tough, cancer has proved to be a formidable foe against generations of bright and well-funded researchers.

Although there was never an official declaration, military rhetoric became the cliché among journalists covering cancer research as President Nixon signed the U.S. National Cancer Act in December 1971. The "reconnaissance" might be completed in labs and "offensives" inside the body, but like the war on drugs and the war on terror, trying to root out this disease has been more difficult and more expensive than originally hoped.

In the past 40 years, the National Cancer Institute has spent some $90 billion on research and treatment. And national estimates peg the annual price tag of cancer care at about $125 billion in 2010, noted reporter David Malakoff in a special section of Science‘s March 25 issue, commemorating the 1971 bill’s signing.

Contributing to this ever-growing tab are a combination of larger patient pools and pricier drugs. Although they are the minority, some individual therapies can cost tens of thousands of dollars and bring less than an extra year of survival. And as more people live longer after their initial diagnosis, the costs of treatment are projected to keep climbing. By 2020, treating the most common forms of cancer is likely to increase 27 percent to some $157.7 billion—regardless of whether the price of treatment itself increases—according to a January report in the Journal of the National Cancer Institute.

And like the attack on other nebulous, if more macro-scale enemies such as drug cartels and terrorist cells, cancer is a slippery and diverse entity. More than 100 forms of the disease are currently recognized, making it nearly impossible to create uniform models or stats. Within those many categories, individual cases present with innumerable variables, driving interest in personalized therapies, such as Provenge, which was approved by the FDA in 2010.

This direction is, however, often at odds with current policy pushes to assess larger populations of patients to find trends in effectiveness. And the doctors in charge of charting treatment strategies struggle to apply large data sets—when they are available—to individual patients, for whom they more often than not are prescribing cancer drugs for purposes other than those for which they have been approved, a practice known as off-label use.

Even within a single patient, "the population of cells in a tumor is quite heterogeneous, making it very unlikely that any single therapy can target them all," Science editor-in-chief, Bruce Alberts writes in the new issue. And "by the time most cancers are detected, a tumor has grown to contain more than a billion cells. Through a process resembling mutation and natural selection stretching over many years, these cells have become altered in ways that allow them to escape from the large number of failsafe mechanisms that normally protect the human body."

Meanwhile, researchers are still sorting out the basic biology of cancer development, such as how it spreads into other organs of the body, a process called metastasis. As Christine Chaffer and Robert Weinberg, both of the Whitehead Institute for Biomedical Research and Massachusetts Institute for Technology, note in their paper in Science, "Metastasis causes the most cancer deaths, yet this process remains one of the most enigmatic aspects of the disease."

As cancer’s core has proved almost impenetrably complex over the past decades, study of the disease has been spreading rapidly into new disciplines, such as genetics, genomics and immunology. The immune system plays key roles in warding off cancer, Robert Schreiber, of the Washington University School of Medicine, Lloyd Old, of the Memorial Sloan-Kettering Cancer Center, and Mark Smyth, of the Peter MacCallum Cancer Center in Australia, wrote in their paper in the new issue of Science. "The immune system controls not only tumor quantity but also tumor quality."

Since the U.S. boosted its funding to beat back cancer 40 years ago, mortality rates are in decline, falling 21 percent for men and about 12 percent for women between 1991 and 2006, according to the American Cancer Society. More than 1.5 million new cancer cases were expected in 2010, which is up from the more than 1.3 million anticipated new cases in 2005, the group estimated.

And the disease has made serious inroads into other countries that have far fewer resources to manage it. In places where even general practitioners are few and far between, such as Rwanda, well-equipped oncologists are practically an anomaly, writes journalist Martin Enserink this week in Science. In some of the world’s poorest countries about nine in 10 children diagnosed with leukemia will die from the disease, whereas in Western Europe survival is about 85 percent, he reports.

Image courtesy of iStockphoto/Eraxion





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  1. 1. BuckSkinMan 11:45 am 03/25/2011

    SciAm IT people: your efforts to fight "SPAM" ads in your comments sections are failing.

    Cancer: continues to be a personal tragedy affecting millions of people every minute of every day. But Science will win in the end.

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  2. 2. bobsmith1234 5:36 pm 03/26/2011

    I think we are winning the war, but it will continue to be long and drawn out. If the current trends are predictive, it probably won’t be a miracle cure all of a sudden, but personalized medicine to get where we need to be, which will take science lots of time and more importantly as of current, money. We’ll have to continue to learn more and more about the specific cancers (lung, breast, colon, etc), and learn more and more about the subsets of cancers within these classes. That is to say, breast cancer expressing gene A and B but not gene C and D, the best treatment course is with X and Z. And cancers with different profiles will require different treatments.

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  3. 3. Malcoolm 6:33 pm 03/28/2011

    Cancer can be prevented and reversed by way of nutrition. If you want to be informed, please read "The China Study". We do not need treatment, surgery or other intervention. All we need is a whole foods, plant based diet and most, if not all, of our maladies will disappear.

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  4. 4. achilles22 8:26 pm 03/28/2011

    It is only logical that as mutations accumulate in the human genome, we will see more cancers. Carry on the fight, but expect more instances of cancer.

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  5. 5. gem1115a 11:12 pm 03/29/2011

    Many different remadies have been found to help stop cancer from metastisising or growning new blood supplies leading to the death of cancer cells, yet few doctors do any of these because no drug company visits thier office to promote them. Drug companies marketing is manage disease not cure it …there is not as much money in cure as in making the disease cronic.

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  6. 6. jgrosay 4:47 am 03/30/2011

    Because other curable diseases are reducing their importance, as the size of cancer is more or less constant, its share increases, but now more than 60% of cancers can be cured, there are screening tools for many of them that allow early diagnosis, thus improving end results, and medical science is discovering personalized ways to cure or relievement. In non developed countries, most cancers have a genetic background, and start at younger ages, while in our nations, many cancers are environmentally induced, and thus preventable, we just need to discover the harming agent

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  7. 7. Tomkeen 6:05 am 03/30/2011

    I agree that cancer can be tragic, especially if it is somebody who is young. But I think that people forget that we all have to die of SOMETHING. I am disabled and ill in general but nothing that will kill me. But it has made me a strong believer in Quality rather than Quantity of life. Even to the point of believing in euthanasia. (That will make a lot of people angry.) I do not want to live with the problems I have to a great age where I am gaga, physically confined to bed or both. Saving the life of a thirty year old person with young children is one thing; saving the life of somebody who is elderly for that person to die 1 year later of old age is another.
    If I knew chemotherapy was going to give me an extra 5 years of quality I would take it and thank all the researchers that made it possible; if it was going to be only an extra 6 months I would not want to go through the hell of chemotherapy.
    As one commenter said the overall percentage of deaths is the same the proportion of survivors is going up. That shows two things, there has been a huge improvement in the effectiveness of the treatments and also the success of treating other diseases such as heart disease.

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  8. 8. hoamingin 7:35 am 03/30/2011

    Malcoolm,

    I agree with you on diet, but Campbell’s The China Study claims more than the facts can support. See this link:
    http://www.sciencebasedmedicine.org/?p=6092

    I personally eat mainly vegetarian, but the almost total neglect of diet by the medical sciences for most of the last century means there is miniscule scientific evidence. For a long time soy was touted as a miracle health food, until studies showed it is almost the opposite, a food to be avoided.

    Until there are definitive studies, we have to work out for ourselves what we think is best, and I think we should certainly cut out processed foods, sugar and try to eat food as close to natural as possible, with minimum exposure to chemicals. That is why I do not eat chicken and only eat meat from grass fed animals.

    The clearest scientific evidence is that a high level of vitamin D (80+ nmol/L) is preventative. I live in Australia, which is melanoma central, courtesy of too many people spending too long in the sun to become Bronzed Aussies. To break the habit, the Cancer Council has been running a large public health campaign to encourage people to stay out of the sun, so we now have an epidemic of vitamin D deficiency. In a couple of decades we may find out whether a reduction in melanoma outweighed an increase in other cancers, osteoporosis and other ailments.

    Complex interactions among many factors make it almost impossible to use traditional methods of producing medical evidence. This article referred to broader population studies, which have more chance of coming up with sensible guidance on healthy diets.

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  9. 9. hoamingin 7:44 am 03/30/2011

    Achilles22,

    What you are suggesting is a genetic connection, which has not been found to exist. As others have commented, if we find treatments for some diseases, the incidence of cancer will increase because there is an age correlation.

    But the most likely cause of the increase is environmental. People are eating too much, or the wrong things, and often too much of the wrong things, so internal organs are constantly under stress. They are also under stress from levels of environmental contaminants that simply did not exist in past generations. One way or another, humans have been finding ways to poison themselves.

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  10. 10. barbie doll 4:07 pm 03/30/2011

    Why won’t anyone listen to Burzynski?!

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  11. 11. Quinn the Eskimo 2:16 am 03/31/2011

    What with the CDC afraid to fund "radical" therapies, and "cancer" being this nebulous collection of stuff — has anyone yet

    agreed upon a definition of "CANCER"?

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  12. 12. Davidino 2:33 am 03/31/2011

    As chairman of the National Cancer Institute, President Nixon appointed Benno Schmidt, a senior drug company executive with close ties to chemical, oil and steel industries. Following him was Armand Hammer, late oil magnate and chairman of Occidental Petroleum, a major manufacturer of industrial chemicals. Both ignored cancer prevention and the influence of industrial carcinogens. Instead they focused on the highly profitable development and marketing of cancer drugs.

    NCI’s conflicts of interest have remained unchanged despite the escalating incidence over the last three decades of childhood cancers and adult cancers unrelated to smoking, and despite substantial evidence relating these cancers to avoidable exposures to industrial carcinogens.

    Nutrition plays a vital role in the prevention of cancer but Dr. Campbell’s China Study proclaiming the merits of an all-plant based diet has been thoroughly discredited. Seems that Dr. Campbell manipulated his raw data so as to reach a prior conclusion. Here young Denise Minger delves into the details of The China Study to create a critique that could serve as a model of statistical analysis. http://rawfoodsos.com/2010/08/06/final-china-study-response-html/

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  13. 13. achilles22 7:50 am 03/31/2011

    I’m not sure I’m following you. Mutations in the genome are responsible for genetic cancers such as breast, prostate, ovarian, colorectal. These are not environmental causes. There are genetic causes of cancer.
    Hereditary cancer is a cancer that has developed as a result of a gene mutation passed down from a parent to a child. Inheriting a gene mutation does not necessarily mean that person will develop cancer, but increases their risk factor.

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  14. 14. bucketofsquid 10:10 am 04/4/2011

    You are mistakenly equating an 80% child mortality rate with a magic bullet cure all vegan diet. Vegans get cancer too as well as other illnesses. If you want to be taken seriously you need to abandon the all or nothing fanaticism and embrace a balanced science oriented view.

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  15. 15. bucketofsquid 10:15 am 04/4/2011

    Probably because most of us have never heard of Burzynski or how ever it is spelled.

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  16. 16. Cancerkiller 7:42 pm 10/29/2013

    Everybody can rest assured. The war on cancer can be considered won. Nature has provided us the unlimited power of being as healthy as Gods, we just gotta activate it.
    Any cancers and any infectious diseases on Earth (some of them known to cause cancer) can be erased from the face of the planet, once everybody (kids and adults) start doing my discovery – the PCK – The Personal Cancer Killer – the complete prevention and cure (for those now sick) for kids and adults of any diseases – from the common cold to cancer – just an exercise for a minute a day for prevention and for 2 – 3 minutes a day for the cure (for max. 30 days – no recurrences of any cancers guaranteed). Cancer Killer is by far more powerful than the immune system itself, keeps it intact all the time. No killer viruses, bacteria, germs and cancers on Earth got any chance against the tremendous power of the Cancer Killer – they just die the moment they touch you.
    The price of the Cancer Killer for the whole world is $9 Billion. I accept checks of $5 Million to disclose it personally and how one can stay absolutely healthy all the time, all life long – never getting sick of any diseases, regardless of age, lifestyle, etc., even for a second.

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