Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: MONDAY, July 23, 1990                   TAG: 9007230066
SECTION: NATIONAL/INTERNATIONAL                    PAGE: A/8   EDITION: METRO 
SOURCE: MARY KNUDSON THE BALTIMORE SUN
DATELINE:                                 LENGTH: Medium

IN THE WAR ON CANCER, SCIENCE MAY BE LOSING

Next year will mark two decades since former President Nixon, responding to a concerned Congress and a panel of experts, declared a formal war on cancer and the government boosted spending for cancer research.

How far have we come in 20 years of fighting cancer? Is it a war we will either win or lose?

As the last decade of the 20th century begins, this is where we stand:

As in 1970, cancer remains the second-biggest killer of American men and women after heart disease. Worse, the National Cancer Institute predicts that cancer will surpass heart disease in the next 10 to 20 years.

Death from heart attacks dropped 43 percent from 1970 to 1987, according to the American Heart Association. By contrast, the overall death rate for cancer - age-adjusted to eliminate the effect of a population growing older - keeps increasing.

A revolution of knowledge in biology and biochemistry is making it possible for scientists, bit by bit, to understand the progression of cancer and possibilities for early intervention. The last decade has been an exciting, even profound era of discovery, but many mysteries about cancer remain.

The incidence of cancer is rising starkly - up 15 percent from 1973 to 1987. Some cancers rose considerably more: melanoma, by 83 percent; non-Hodgkin's lymphoma, 50 percent; prostate, 46 percent; testis, 39 percent; lung, 31 percent; and breast, 23 percent.

Rate of survival, another way to judge progress in cancer control, has increased only slightly - by 1.7 percent from 1974 to 1986 (the years for which the National Cancer Institute has a common data base). Today, the five-year survival rate for cancer patients is 51 percent. And some who pass the five-year benchmark later succumb to the cancer.

This year the National Cancer Institute, which funds 50 percent of the nation's cancer research, had a budget of $1.5 billion. The other half of basic and clinical research relevant to cancer is paid for by other federal agencies, industry, non-profit organizations, and state and local governments.

But is the estimated $3 billion enough? How far can money go in conquering a major disease?

Many scientists as well as cancer institute officials say that basic leads for understanding cancer are there to be followed, but opportunities are being missed for lack of money. About three of every four research grant applications to the cancer institute go unfunded.

Today Congress is faced with increased pressure to balance the federal budget, and there is more competition for the pool of research money. AIDS has captured more public attention than cancer and a large share of federal money.

There are at least five major obstacles to conquering cancer, the experts say. Scientists must overcome four:

The problem of metastasis - when cancer spreads from its original site to other organs of the body, making treatment much more complex.

Incomplete understanding of the basic biology of how cancer starts and progresses and how to intervene early in the process to halt cancer growth.

The ability of most cancers to become resistant to the multiple drugs used to fight the cancer.

The problem of recurring cancer. If even one cancer cell is able to survive treatment, it can multiply, and the resulting cancer, even more virulent and drug resistant, can kill. Sometimes, the second cancer is caused by the treatment used against the first.

The fifth obstacle? Getting individuals to change their lifestyles to prevent cancers that are preventable.

No matter what scientists and government do or don't do, a big challenge rests with the individual. Tobacco use is responsible for a third of all cancers. Melanoma caused by sun exposure is increasing faster than any other cancer. Many experts feel there is enough evidence - though spotty - to recommend a diet low in fat and total calories and with daily servings of fruits and vegetables.

If all women got an annual Pap smear that can detect pre-cancerous changes in the cervix, cervical cancer could practically be wiped out. Mammograms are highly useful in detecting early breast cancer, but surveys have found that most women in the age group at highest risk are not getting them.