WASHINGTON. — Washington -- How goes the war on cancer, now in its 20th year?
An unrealistic optimism prevailed when Richard Nixon, prodded by the Congress, signed the National Cancer Act into law on Dec. 23, 1971. Kindly but foolish congressional resolutions called for curing cancer in time to commemorate the 1976 bicentennial of American independence. Research funds rapidly increased, though the blank checks promised by the law were never delivered.
Today, the disagreeable reality is that, while some battles have been won, victory in the ''war'' remains far off. True enough, there has been remarkable progress in the treatment of several types of cancer and recent scientific findings promise even greater progress. But the good news is shadowed by worrisome evidence that several types of cancer are becoming more common, for reasons that have so far eluded discovery. Careful studies suggest that the increase is real and not merely the result of better diagnostic techniques.
Seen in many industrial countries, the puzzling jump in cancer cases raise volatile questions about the balance of resources between treatment and prevention. And, inevitably, the adequacy of environmental regulations have come into question, though the evidence of pollution and toxic waste as culprits in the increase in cancer is spotty, mixed and controversial.
Any attempt at a simple snapshot of the status of the war on cancer is fogged by statistical complexities. In terms of deaths attributed to cancer in the United States, the plain numbers are dismaying: 335,000 in 1971 versus 514,000 estimated for 1991. But plain numbers are misleading, since the population has risen from about 200 million to 250 million in those 20 years. And, especially important, more people now live into the advanced ages where cancer is most common.
However, even when the cancer statisticians adjust the figures to account for aging, the increase in incidence of certain types of cancer is alarming. Thus, the National Cancer Institute reports that the incidence of breast cancer rose from 84.8 cases per 100,000 women in 1980 to 112.5 in 1987. The institute said that ''the long-term increase in breast cancer incidence is difficult to explain.''
Other types of cancer have also been reported on the rise. Brain cancer in persons under age 45 increased by 2 percent a year between 1973 and 1987, according to a report this year in the American Journal of Industrial Medicine. The authors noted that similar increases have occurred in Britain, West Germany, France and Italy. They disputed the possibility that reports of higher incidence are really the result of better diagnostic techniques, rather than more cancer.
The managers of the federal cancer program point out that among cancer patients under 65, earlier detection and improved treatments are cutting the death toll in many types of cancers. Thus, between 1973 and 1986, the mortality rate for bladder cancer decreased by 29 percent, while the rate for the so-called children's cancers fell by 35 percent.
That's the good news, but in the over-65 population, the death rate from cancer is on the rise, despite the better treatments, thus raising doubts about whether the war on cancer has devoted sufficient attention and resources to prevention. Prominent among those expressing these doubts is Dr. John Bailar, professor of epidemiology and biostatistics in the faculty of medicine at McGill University and for many years statistical consultant to the New England Journal of Medicine.
Noting that cancer death rates for older ages have increased rapidly, Dr. Bailar has warned that ''the worldwide effort to control cancer has failed to attain its primary objective -- substantial reduction of the overall cancer death rate -- despite 40 years of intense effort that has been focused mostly on treatment.'' The urgent need, he said, ''is to increase research efforts to find more effective, more feasible ways to prevent cancer.''
Is environmental contamination the villain in the mysterious increase in various cancers? A newly released study by the National Research Council notes that 40 million people live near major hazardous-waste dumps, but that little research has been conducted to ascertain the health effects of that proximity.
Prevention is no longer as neglected as it once was in fighting cancer. But at the dawn of the third decade of the war on cancer, the ominous trends call for even greater emphasis on stopping the disease before it strikes.
Daniel S. Greenberg publishes Science & Government Report, a Washington-based newsletter.