Earlier this week, Vice President and Presidential hopeful Al Gore declared a "war" on cancer. He promised to double federal spending on cancer research and make "a flood" of new cancer treatments and tests available to all Americans who need them. He promised that, "if I am entrusted with the presidency, I will work with you to put the same energy and priority into fighting cancer that we would put into preventing a war that could take 500,000 American lives every year." Raising not only the stakes but our expectations, the Vice President claimed that, "we can win this war."
Cancer is now the second leading cause of death, and all Americans of all political persuasions would welcome a reduction in the toll it takes on life and health. Vice President Gore, however, overlooked three important factors in his declaration of "war." Without acknowledgement of these factors, the war becomes unfocused with unattainable goals.
First, our goal should not, and cannot be to wipe out all cancer. Cancer is a disease of aging. Indeed, with the precipitous decline of heart disease we are witnessing, it is likely that cancer soon will be the leading cause of death in America. Given the inevitable reality of human mortality, something has to be the leading cause of death. Our goal, then should not be to prevent cancer or death but to prevent PREMATURE deaths.
Second, the more we learn about cancer, the more we realize that the "war" against it should focus first on PREVENTION, a topic that does not appear to have high priority in Mr. Gore's "cancer war." For example, we know now that nearly 40% of cancer deaths this year will be causally linked to the use of tobacco, primarily cigarettes. We know that overexposure to sunlight is a major cause of the most deadly type of skin cancer, melanoma. Further. we strongly suspect that a dearth of fruits and vegetables in the diet leaves us vulnerable to some forms of cancer.
And there is in process a significant amount of research in what is known as "chemoprevention" of cancer, that is pharmaceuticals which reduce a persons risk of certain cancers. We know, for example, that the drug tamoxifen reduces the probability of breast cancer in high risk women. We suspect (but do not have firm data yet,) that another drug, raloxifene, will also reduce breast cancer risk. Currently there are trials underway testing new arthritis-pain drugs to see if they will prevent colon polyps and colon cancer. The message here is that an ounce of prevention is worth more than the many pounds of "cures" and treatments which Mr. Gore gives high priority.
Third, any war on cancer must focus on real, not hypothetical, causes of cancer if it is to be successful. Unfortunately, Vice President Gore himself has for years been guilty of calling attention to "chemicals" (like the pesticide DDT) in the environment as causes of cancer. Mr. Gore has supported efforts of the Environmental Protection Agency to "protect" us from other trace levels of environmental chemicals which are "carcinogens" only by virtue of the observation that they cause cancer in high doses in laboratory animals. Mr. Gore's war on cancer would have a far greater chance of success if it would begin by identifying the real enemies.
