Cancer 'war' called skirmish Hopkins researcher demands more from 2nd 25 years of battle

December 22, 1996|By Jonathan Bor | Jonathan Bor,SUN STAFF

Twenty-five years after the United States launched an all-out "war on cancer," the incoming president of America's top cancer research organization asks, "What war?"

His question comes despite recent evidence that cancer death rates have finally started to decline after decades in which news from the battlefront was usually discouraging.

Nobody believes more fervently in the cause than Dr. Donald S. Coffey, a Johns Hopkins researcher who decided to commit his life to cancer while meditating beside a bread-wrapping machine in the Tennessee bakery where he once worked.

"See why I'm so excited about all the things happening in the field?" he exclaimed recently, nearly leaping from his chair after describing experimental gene therapies, cancer vaccines and molecular manipulations that might replace the cruder treatments of today.

But Coffey said efforts have been stymied by insufficient funding, leaving many young researchers without the money to pursue imaginative strategies.

"They're calling it a war when I say it's a skirmish," said Coffey, 64, starting one of the impassioned, rhetorical rolls for which he is known.

"I think one-tenth of a penny out of your tax dollar is not enough for something that half the males and a third of the females are going to get and one out of four people are going to die of.

"You're going to have to die of something, but this is not one you want to die from," Coffey said. "I don't want to frighten patients, but this is not pleasant: Severe bone pain that can't always be controlled. Pathological fractures."

He went on, "I don't think we have to hang our heads in shame over the progress that's been made. What we have to hang our heads in shame over is how little money has been put into this.

"I want a real war declared on cancer."

In April, Coffey will start a one-year term as president of the American Association for Cancer Research, an 8,000-member organization dedicated to the exchange of new ideas.

He said one of his primary missions will be to persuade the public -- and the Congress -- that the $2.3 billion in federal money being spent this year on cancer research is not nearly enough.

Cancer is the No. 2 killer after heart disease, claiming more than a half-million victims each year. After almost a century of steady increase, cancer death rates fell between 1991 and 1995.

The overall mortality rate, adjusted for age, dropped each year during the period for a total decline of 2.6 percent.

The largest reductions were among African-Americans, a group that has been hit disproportionately hard by cancer. The decline was steepest among black men, whose rate dropped 8.1 percent, compared with black women, whose rate declined 2.5 percent.

But cancer mortality remains significantly higher among African-Americans than whites. Dr. Richard Klausner, director of the National Cancer Institute, blames the disparity on several factors, including poorer access to care and less aggressive treatment.

"One of the unacceptable facts of our nation's cancer burden is that it is unevenly distributed among our population," Klausner said in this month's Journal of the National Cancer Institute.

Coffey's term comes as scientists and policy-makers are waiting to see whether the decline represents a historical turning point, as Klausner contends, or just a brief downturn.

Tomorrow marks the anniversary of the day President Richard M. Nixon signed legislation to increase federal oversight and funding for cancer research. He promised "an unprecedented attack a great crusade." The president of the American Cancer Society said it would be "the greatest thing ever done by the United States."

In 25 years, the nation has poured $28 billion into research. Half of the money has been spent on basic science -- deciphering the inner workings of cells -- while the rest has gone to treatments and prevention.

Despite the assault, overall cancer deaths rose by 6.3 percent between 1973 and 1992. Huge strides were made against childhood cancers such as leukemia, lymphoma, Hodgkin's disease and testicular cancer.

But statistically, the improvements were overwhelmed by increased deaths from lung and prostate cancers and many other malignancies that strike adults.

The recent gains are modest, but Coffey said the quarter-century performance is really better than one might think. If one sets aside lung cancer deaths -- a big set-aside -- mortality from all other cancers declined 3.4 percent since 1976.

He made that statistical leap for a reason: Lung cancer is, by far, the largest cancer killer. Smoking accounts for nearly all cases but takes decades to trigger the disease. And while the habit has been waning for many years, society has only recently begun to see the reward that matters most -- fewer deaths.

There are several reasons for the progress against other cancers, he said.

He credited better diagnostic procedures -- such as the PSA blood test for prostate cancer -- that enable doctors to catch some tumors early enough to be cured.

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