In 1971, Richard Nixon famously declared war on cancer and predicted that medical technology would find a cure for it 'within six years' - a boast to rival Kennedy’s goal to put man on the moon. But while the might of US technology conquered space within a decade, conquering cancer has proved rather more difficult.
Since then, the total amount spent on cancer research and treatment is estimated to have passed the two trillion dollar ($2,000,000,000,000) mark (Wall Street Journal, 16 Oct 2002). Most of that money has come from us taxpayers, patients, consumers and donors to cancer charities.
What have we got to show for it? If you listen to doctors, the drugs industry and cancer charities, the constant refrain is that the war against cancer is being won - or at least that there’s a cure just around the corner.
But are they right? Let’s start with the crude cancer-mortality rates in our so-called developed world.
Despite the might of medicine, in every year from 1971 to 1991, more Americans died of cancer than the year before - this in a country with the most advanced medical care in the world and the best cancer records. Although there’s been a slight fall in the last 10 years, the plain truth is that cancer deaths have doubled over the last 30 years.
This embarrassing statistic is often explained away by the fact that we’re living longer (supposedly thanks to medicine), and so more of us are alive to contract degenerative diseases like cancer.
But if you ask an expert like Dr John Bailor, this excuse won’t wash. Bailor was a senior cancer statistician for the US National Cancer Institute for 20 years and editor of its journal. 'Cancer death rates continue to go up year after year,' he said in 1985. 'These are real increases . . . This has been going on quite steadily for a number of years now' (Address to the Annual Meeting of the American Association for the Advancement of Science, May 1985).
Ten years later, Bailor again looked at the figures and concluded: '. . . years of intense effort focused largely on improving treatment must be judged a qualified failure' (N Engl J Med, 1997; 336: 1569-74).
Similarly, in Britain, death rates increased up to the end of the 1980s, but have since slightly declined. But, at the same time, some cancers have risen alarmingly. For example, there were only 3300 prostate-cancer deaths in 1964, but 8600 in 1998. Teenage cancers, too, are on the rise - by more than 1 per cent a year for the last 20 years (Br J Cancer, 2002; 87: 1267-74).
Biopsies cause cancer
Once a cancer has been isolated by screening (see box, p 2), doctors need to confirm the diagnosis, using diagnostic tests such as a positive prostate-specific antigen (PSA) reading or a biopsy, which involves taking tissue cores (from as many as 12 different sites in the case of the prostate) to check for cancer cells.
But the procedure is not without risk: most patients become infected because of the procedure, 20 per cent suffer severe pain, and 15 per cent are rendered impotent (J Urol, 2001; 165: 445-54). To add insult to injury, biopsies themselves may be inaccurate, often failing to detect cancerous tissue (Prostate Cancer Prostatic Dis, 2000; 3: 13-20).
But the crowning absurdity is that biopsies can actually spread cancer, thus precipitating the very disease they are trying to diagnose. This alarming discovery was first made about 50 years ago, when a case of prostate cancer was found to have been spread by biopsy (J Urol, 1953; 70: 937).