Where Are We in the War on Cancer?

The following has been excerpted by The Death of Cancer, by Vincent T. Devita and Elizabeth DeVita-Raeburn.

When I was a child in the 1940s, long before I had any notion of becoming an oncologist, Aunt Violet, my godmother and a frequent visitor in my household, stopped coming over. My parents ceased talking about her, too. It was as if she had disappeared. Several months into this state of affairs, my father drove me from our home in Yonkers to her apartment in New York City. He told me that she was sick and that she wanted to see me.

We went in, and I sat on the living room floor, playing with the toy car Aunt Violet had given me. The Ink Spots crooned “If I Didn’t Care” from the record player. Aunt Violet was a bubbly woman, by far my favorite relative. We had a special bond. It was just like her to put on the music I loved when she knew I was coming.

I looked up when I heard the bedroom door open. The Aunt Violet I knew was vivacious, with dark brown eyes, curly brown hair, and a voluptuous figure; the woman who stood watching me was quiet, gaunt, and sad. Her skin looked yellow next to her white chenille bathrobe. I was only six, but I knew something was terribly wrong.

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I knew also that I should talk to her, but I didn’t know what to say. I ducked my head and began running my car around the legs of the record player, too scared and confused to look up. I was acutely aware of her standing there, silently, watching me. Finally, my father told me it was time to go home. I picked up my car, and we left. Several weeks later, my parents told me that Aunt Violet had died. She was just thirty-six.

Years later, I learned that she’d had cervical cancer. Her case had apparently been so advanced by the time she was diagnosed that there was little her doctors could do. There wasn’t much that could be done for most people with cancer in those days, even if it was caught early.

The main treatments were surgeries that were often disfiguring or toxic doses of radiation. Those treatments helped only the lucky few whose cancers were discovered before they had spread. There were no drugs to fight cancer then. And barely more than a third of people diagnosed with it survived.

It was such a dreadful diagnosis, in fact, that many people, including my parents, couldn’t bring themselves to utter the word. If they did, it was in a whisper—“cancer”—as if there were something shameful about it. Or maybe it was superstition, the fear that merely saying the word out loud was tempting fate, like waving a red cape in front of a bull. Individuals like my aunt were the incarnation of people’s worst fear: apparently healthy one minute, facing certain death the next.

Two decades after my aunt’s death, as a newly minted doctor, I found my career taking an unexpected turn. A couple years after graduating from George Washington University’s medical school, I walked onto the cancer wards at the National Cancer Institute (NCI), a reluctant trainee. I wanted to be a cardiologist, but Vietnam was in full swing, and doctors weren’t exempt from the draft. The National Institutes of Health (NIH), which included a number of disease-specific institutes, was one of the few legal outs. It was part of the Public Health Service, which was considered one of the uniformed services. If you served there as a clinical associate—that is, a trainee—you got credit for serving in the armed forces. I’d blown my interview for a spot as a clinical associate at the National Heart Institute. Yet I’d been offered one at the National Cancer Institute. It was a depressing assignment. But it was fighting cancer or stitching people back together on the battlefield. I chose cancer.

At the NCI, I saw a lot of people who looked just like my Aunt Violet had at the end of her life. Gaunt. Sad. Yellow. In the many years since her death, neither the treatments nor the survival rate had changed much. People still whispered the word “cancer.” One of my first patients told me that when he and his wife took their evening walk, their neighbors quietly slipped away, as if what he had were catching. At cocktail parties, even his friends served him his drinks in paper cups, so fearful were they that his disease, or his bad luck, was contagious and couldn’t be washed off the glassware.

The study of cancer was a stagnant field, a no-man’s-land populated by only a handful of doctors and researchers regarded by most of their colleagues as nuts, losers, or both. That’s what I thought, too. It was what most people in the medical field believed. When I was a medical student doing my hospital training at George Washington University Hospital, there’d been just one doctor, a beak-nosed endocrinologist named Louis K. Alpert, who dared to try to do more for these patients. He was dosing them with nitrogen mustard, the first anti-cancer drug to be discovered, in the hope that he could kill their cancer without killing them. Nobody thought he would succeed.

“I believe we will see the end of cancer as a major public health issue.”

Most people mocked him behind his back. We called him and his medicine “Louis the Hawk and his poisons.” There were not many like him—physicians trying to extend the lives of cancer patients. More commonly, the patients were sent to nursing homes to die or told to go home and get their affairs in order. That patients might want a shot at something more was not part of most doctors’ thinking. The general feeling was that efforts to cure cancer patients were bound to fail. As late as the 1960s, the respected chief of medicine at Columbia University refused to let his medical trainees make rounds on the cancer wards, lest their careers be tainted by the futility they would encounter there. This chief of medicine told the doctor in charge of this ward, the late Alfred Gellhorn, who did want to try to do more for these patients, that he was “part of the lunatic fringe.”

And so it would have continued, if not for work that would soon begin at the National Cancer Institute, initiated by a handful of mavericks on the same wards where I landed as a trainee in 1963. Their research, in which I took part, led to the first use of a combination of drugs—known as combination chemotherapy—to treat and, increasingly, to cure childhood leukemia. Learning from them, I came up with a combination chemotherapy regimen for Hodgkin’s disease, which cured 80 percent of people with advanced disease.

It was a first, and it did not escape the notice of a brilliant, wealthy socialite and influential health advocate, Mary Lasker, who had lost her own husband to cancer. Before long, with her unique combination of political acumen, medical savvy, and a dedicated pool of lobbyists, Mary managed to convince the president, Congress, and the nation that we were on the brink of a breakthrough and that it was time to invest large sums of money to conquer cancer.

On December 23, 1971, in front of a throng of journalists, a jubilant President Richard M. Nixon signed the National Cancer Act, which launched the war on cancer—an unprecedented federal research effort. The legislation set aside $100 million for the research, to be overseen by the director of the National Cancer Institute, who would be appointed by the president.

Today more than forty years have passed, and the country has spent more than $100 billion on the war on cancer. Where do we stand? What did we get for that huge investment? Many will tell you that we got little or nothing—that the war on cancer has been a failure, that people are still dying, and that you can’t solve a problem by throwing money at it.

I say they’re wrong. I have now seen the war on cancer from every possible angle: as a researcher and clinician at the National Cancer Institute, as the longest-serving director of the National Cancer Institute, as physician in chief at Memorial Sloan Kettering Cancer Center (MSKCC), as director of Yale University’s Cancer Center, as president of the American Cancer Society (ACS), and, most recently, as a patient myself. We are winning.

People still get cancer, and people still die from it. But thanks to this concentrated effort, far more people survive than was true when this war was launched. By 1990, as a result of the investments made by the National Cancer Act, the overall incidence of all kinds of cancers in the United States began to decline, as did the overall mortality rates. These figures have continued to decline every year since they peaked in 1990. By 2005, the absolute number of people in the United States who died of cancer declined even as the population was growing and aging (the risk of cancer is higher in the elderly).

Childhood leukemia is now almost completely curable. Hodgkin’s disease and several types of advanced lymphomas are almost completely curable as well. Even in the case of cancers for which we don’t have an outright cure, we can stop many if they’re diagnosed early. We can even prolong the lives of those in whom cancers are diagnosed at advanced stages. Mortality from colon cancer dropped by 40 percent in the last two decades. Mortality from breast cancer dropped by about 25 percent. We’re seeing major advances in what have long been considered difficult-to-treat tumors, such as ovarian cancer, small-cell and non-small-cell lung cancer, advanced melanoma, and prostate cancer.

The Death of Cancer

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The experience of having cancer is also entirely different. The brutal, disfiguring surgeries of the past have given way to less invasive operations, targeted radiation, and new drug therapies.

When I entered the field, cancer cells were essentially black boxes—mysteries. We couldn’t see inside. Now, as a result of the billions invested in the war on cancer, we have a much greater understanding of why cancer happens and how it behaves, on a genetic and molecular level—an understanding that has led to a breathtaking array of new treatments, biological therapies, and chemicals targeted specifically to the patient’s cancer cells. Immunotherapy, using the patient’s own immune system to fight cancer, has become an established treatment. Advances occur almost weekly; medical journals are bursting with new ideas and therapies.

I believe we will see the end of cancer as a major public health issue. And we have the critical mass of knowledge to get us the rest of the way. We do face obstacles, but most of them are not scientific. Rather, they are in the form of not using what we know and the tools we already have to cure more because of a reluctance to drop outdated beliefs, bureaucratic battles among physicians and medical groups, and a Food and Drug Administration (FDA) that has not caught up with the innovations in cancer drug development.

These issues are well-known to doctors and researchers, but many are reluctant to talk about them overtly for fear that they could damage their colleagues or their chances of getting a grant or anger the powerful FDA. In fact, some of my colleagues are uneasy about my telling this story.

Not long ago, I had lunch with Jim Holland, one of the founding fathers of chemotherapy, the man who recruited the first leukemia patients to the NCI, at a little Italian restaurant down the street from Mount Sinai’s Ruttenberg Treatment Center in Manhattan, where he works. Jim is now ninety, but he hasn’t changed. He’s still got a robust laugh and sports outrageous ties, just as he did when we were starting out.

I told him what I intended to write, expecting his usual boisterous encouragement. Instead, he got a serious look on his face. “Vince, you don’t want to do that,” he said. “The public doesn’t need to know these stories.”

I love Jim, but I disagree. I decided to write this book because I felt that the taxpayers who funded the war on cancer should know how their money was spent and that people with cancer and their families should know what is available for them— and how to make sure they get it. I want to lift the scrim that separates the public from those who study this disease and the individuals and institutions that treat it.

What you will see behind the scenes is not always flattering. The process of science is inextricable from human nature. As James Watson wisely said, in the preface to his autobiographical book about discovering the structure of DNA, The Double Helix, “Science seldom proceeds in the straightforward logical manner imagined by outsiders. Instead, its steps forward (and sometimes backward) are often very human events in which personalities and cultural traditions play major roles.”

It’s true. It will always be true. Watson’s book illustrates it in the search for the structure of DNA. In this book, I show you how it unfolded within the context of the war on cancer. Watson also wisely says that other participants in his story might tell it other ways, either because of the vagaries of memory or because they saw it differently. The Death of Cancer is not a comprehensive look at cancer or an encyclopedia of all the advances made to date. It is my personal take on the war on cancer. The truth in this book is my truth. Others might well tell the story differently.

My message, ultimately, is simple: Don’t believe the cynics, the press, or the doubters. We are winning this war. In The Death of Cancer, I make the case—skeptics be damned—that we have the tools to eradicate cancer and will soon reach the day when “cancer” is no longer the scariest word in the English language. I will tell you how we can get there.

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Excerpted from The Death of Cancer, by Vincent T. DeVita Jr., M.D., and Elizabeth DeVita-Raeburn, published in 2015 by Sarah Crichton Books, an imprint of Farrar, Straus and Giroux, LLC. Copyright (C) 2015 by Vincent T. DeVita Jr., M.D., and Elizabeth DeVita-Raeburn. All rights reserved.