43 percent, and the treatments—disfiguring surgery,
almost unbearably toxic chemotherapy, indiscriminate
radiation—were so dreadful that many patients considered
them worse than the disease.
Today, the five-year survival rate for all cancers is 67
percent. Surgery, chemotherapy, and radiation—still the
triad of successful cancer treatment—are more precise,
causing much less pain and disfigurement. But the real
turning point for patients like Stutman occurred in 1971,
when President Nixon signed the National Cancer Act,
effectively declaring war on a disease that had baffled
doctors since the time of Hippocrates.
There had been wars on cancer before, but this one
would be different. America was fresh off putting a man
on the moon. By comparison, how hard could it be to find
a cure for cancer?
The answer, as we all know, is “much harder.” “The com-
plexity of cancer is wildly underestimated,” says Patrick
Brown, M. D., director of the pediatric leukemia program at
the Johns Hopkins Sidney Kimmel Comprehensive Cancer
Center in Baltimore.
But the National Cancer Act provided an enormous
bump in funding for the National Cancer Institute, which
led to the development of dozens of federally designated
cancer-research facilities nationwide. Those facilities,
says Barry Meisenberg, M.D., director of the Anne Arundel
Medical Center’s DeCesaris Cancer Institute in Annapo-
lis, Maryland, attracted the best minds—which, in turn,
launched an explosion of research into the molecular un-
derpinnings of cancer. And that has led to novel treatments
and a huge upswing in the number of cancer survivors,
from just 3 million in 1971 to about 12 million in 2012.
The number of
cancer survivors
has increased
dramatically
from the early
1970s, when
the National
Cancer
Act was
passed.
( 1971 )
(2012 )
So what makes cancer such a fierce opponent? It’s
smart. “Scary smart,” says Richard Schilsky, M.D.,
section chief of hematology and oncology at University of
Chicago Medicine. All cancers share the trait of patho-
logical cell division, but beyond that, they vary as much as
height and weight among the general population. Because
of that, a successful treatment for, say, colon cancer won’t
work for lung cancer.
“People talk about a war on cancer as if it’s one disease,”
says Bruce Roth, M.D., an oncologist at Washington
University School of Medicine in St. Louis. “One therapy
does not fit all.”
The reason stems from cancer’s molecular origins. Cells
naturally replicate, either to sustain growth or to replace
cells that have died. In healthy cells, this duplication is
regulated, allowing for what our bodies need and no more.
In cancerous cells, mutations take place at the genetic level,
prompting cells to duplicate unabated, leading either to a
tumor or, in the case of blood cancers, exceedingly high
white blood cell counts. Much of the cancer research over
the last four decades has been in pursuit of unlocking the
mystery of these mutations—what causes them and how to
repair them or block their effects.
In addition to its molecular complexity, cancer presents
another abstruse puzzle: heterogeneity. Most cancers
have not one type of mutation but hundreds, often in many
different combinations. And the same cancer can differ
from patient to patient.
PREVIOUS PAGE: INFOGRAPHIC RESEARCH BY BRENDA CASALE; PHOTO CREDI TS ON PAGE 68
“Look under the microscope at the breast cancer of 10
women and they all look the same,” says Judy Garber,
M.D., president of the American Association for Cancer
Research (AACR) and director of the Center for Cancer
Genetics and Prevention at the Dana-Farber Cancer
Institute in Boston. “Yet each will react differently. We
R S OF 400 B.C. ;
1846
Chemotherapy
records its
first, though
temporary,
success with
the remission
of a pediatric
leukemia
patient.
Findings related
to DNA give
rise to molecular
biology.
1947
1950s
Anesthesia
becomes
widely avail-
able. Surgery
to remove
tumors
takes off.
1895
1919
Hippocrates uses the term
karcinos to describe tumors.
Karcinos evolved into cancer.
A chemical in the
mustard gas used
during World War I is
found to reduce white
blood cells. Chemo-
therapy is born.
Wilhelm Conrad
Roentgen invents
X-rays. Radiation
therapy follows.
