When U.S. Surgeon General Luther Terry released a groundbreaking report in 1964 linking smoking to cancer, the disease was a whispered word – and a likely death sentence.
In the decades since, researchers and doctors have worked to stamp out the many diseases known as cancer. And today, the fight against cancer stands at a place of unprecedented progress, with research yielding new drugs, more knowledge about cancer-causing genes, better prevention and improved public awareness.
Dr. Otis W. Brawley, chief medical officer for the American Cancer Society, estimates that more than 1 million American cancer deaths have been averted over the last 20 years.
In “1991 . . . a lot of things that we learned about cancer actually started kicking in,” Brawley said. “It takes a long time to apply them, and then once you start applying them, you finally, finally . . . get to a point where things start getting better.”
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This year, the society is celebrating its 100th anniversary. It was founded in 1913 by a team of New York businessmen and doctors and has since become the largest non-governmental source of cancer research funding. It also provides patient support and focuses on public awareness.
Researchers and physicians such as Brawley have watched in recent years as care has become increasingly personalized and highly targeted. Today, the risk of death from cancer is 20 percent lower than it was 20 years ago, according to society figures.
Certain cancers have seen even greater declines in death rates: There has been a 39 percent decline in colorectal cancer death rates, a 34 percent decline for breast cancer and a 20 percent decline for lung cancer, Brawley said.
Progress has occurred on all fronts, including disease prevention, detection strategies, surgery, radiation therapy and systemic treatments, according to Dr. William Nelson, director of the Baltimore-based Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins.
For progress to continue, innovation like this cannot be stifled by policy change, said Andy Hill, a Republican state senator in Washington’s 45th district, just east of Seattle, who was diagnosed with lung cancer in 2009 at age 46.
“My hope is that when my kids are 50, 60, 70, and they’re diagnosed with cancer, they do a test and take a pill to vanquish it,” he said.
Given recent advances, Hill’s vision seems increasingly possible.
According to researchers, new knowledge about what goes wrong in cells and the study of specific genes is creating more pinpointed treatments. Further, the development of anti-cancer drugs has taken off and become more cost effective, making it easier to get new drugs approved, Nelson said.
“As we have defined the processes that are involved in a cell becoming cancerous, we’ve actually started redefining cancer,” Brawley said. “We’ve gone from a 19th century definition of cancer to a 21st century” one.
“That will help us fine-tune our treatments even further,” he added.
Under this new definition, a patient’s specific type of cancer will be less important than which gene causes it. Doctors can identify the genes that are “acting up” and use targeted drugs to block their activity, Brawley said. Some such drugs are already being successfully used.
Chronic myeloid leukemia, breast cancer and prostate cancer are among the diseases that have responded well to these gene-targeting treatments, said Dr. Ruben A. Mesa, deputy director of the Mayo Clinic Cancer Center and chair of the division of hematology and medical oncology at the Mayo Clinic Arizona in suburban Phoenix.
“Really, it is a tremendous era of trying to individualize cancer care,” Mesa said. “We’re at the beginning of the new wave.”
Hill, the Washington state senator, was among the first patients to ride that wave. After his cancer spread to both lungs and his lymph nodes, Hill found a trial drug called crizotinib that could target his specific gene mutation.
“It was really miraculous. Within a week most of my symptoms had disappeared and within three weeks I was jogging again,” he said.
Hill is an example of an increasingly common new breed of cancer survivor: one who may not be cured but can live with the disease.
“I’m not able to say that we’re going to have a cure,” Brawley said. “My vision of cancer in the future is that many of these diseases are going to become much more like diabetes: They will be chronic diseases.”
Other doctors are optimistic that some cancers can still be eradicated completely.
“We are curing cancers, even in a very advanced stage, ever more often than we were,” Nelson said. “There’s a huge amount of hope that we finally understand enough about how the immune system works that we’re going to be able to use it to control and eradicate these cancers more effectively.”
The progress has been aided by increased public awareness and better prevention. As facts about cancer become common knowledge, people are becoming more proactive about health. For example, self-detection is now the second most common way breast cancer is found, Brawley said.
Public figures frequently speak out about their diagnoses, following a trend started by first lady Betty Ford, who made waves in 1974 when she openly discussed her breast cancer. Advocacy groups provide everything from brochures to educational retreats. Large-scale fundraising events like Relay for Life and the Susan G. Komen Race for the Cure loudly and proudly bring cancer to the public eye.
On the other side of awareness, however, is stigma.
Many taboos about cancer have fallen away as American society has advanced along with medicine. But misperceptions remain, particularly with diseases whose potential causes lend a stigma to the diagnosis. That includes cancers of the lung, cervix, and head and neck.
“There is definitely a stigma of lung cancer that makes it harder to get funding,” said Hill, who never smoked. “Part of it is getting more survivors like myself so I can talk about it and advocate for it.”
Funding is arguably the most vital link in the chain of continuing progress.
“One of the problems of talking about this today is that the federal research program is being impacted right now by the government shutdown. It’s a juxtaposition of the most promising signs (of progress) ever and some very unfortunate political decisions leading to an unnecessary slowing of research,” said Dr. Clifford A. Hudis, chief of breast cancer medicine service at Memorial Sloan-Kettering Cancer Center in New York and president of the American Society of Clinical Oncology, referring to federal budget cuts and the current government shutdown.
In spite of such challenges, experts agree that the fight against cancer is at a better place than ever.
At the American Cancer Society’s anniversary celebration in May, CEO Dr. John R. Seffrin said he is ready to put the society out of business.
“We’re determined to make this cancer’s last century,” he said.
“If you were to take someone from 1973 to 2013 in terms of the transformation of the diagnosis, the treatment and the recovery from cancer, it’s truly unbelievable,” the Mayo Clinic’s Mesa said. “There are many cancers that are now curable that were incurable, and there are many cancers where . . . people will live for many years where before they would’ve been catastrophic. It has been an unbelievable era of change, and I think these next 10 years may even put all of that in the past.”