EDITORIAL

www..com/clinicalpractice/onc The ‘War on ’ and its impact Vincent T DeVita, Jr

On 23 December, 33 years ago, President …the ‘War on mainly treatment oriented and predominantly signed the National Cancer Cancer’ has aimed at patients with advanced and Act of 1971, initiating what has been euphe- measured the success of the whole effort as mistically called the ‘War on Cancer’. The Act had a profound accordingly, but neither assumption is true. described a simple mandate: “Support research impact and Despite the testing of many drugs in patients and the application of the results of research, to succeeded with advanced disease, other criticisms include reduce the incidence, morbidity and mortality in fulfilling its “the survival of patients with advanced colon from cancer,” often qualified by the phrase “in mandate cancer has barely budged since 1970”. We so far as feasible” to acknowledge the absence often see press statements that new ‘sen- of all the tools necessary to accomplish the sational drugs’ for are task at the time. No timeframe was stated in expensive, and, while they are described as the Act. Actually, the ‘War on Cancer’ has had ‘breakthroughs’, they barely prolong the life a profound impact and succeeded in fulfilling its of patients with advanced disease. Ironically, mandate. In the US, for example, overall inci- this is actually true. Nevertheless, if you assess dence, mortality and, in particular, morbidity colorectal cancer in its entire context, mortal- from cancer have decreased, and relative sur- ity rates have decreased over 40% in the last vival rates for all have increased 70%, three decades. How did that happen? since the passage of the Act. This is partly because of applications of We will see the effects of this program on a newly developed diagnostic tools, but to a monthly basis in this journal, hence my call- large extent this can be explained by the trans- ing it to your attention. The 80–85% of the fer of therapies tested in patients with meta- $50 billion spent by the US National Cancer static cancer (where they are partly successful Program worldwide was invested in support but do not cure) to the adjuvant situation where for basic research programs, and these invest- they work much more effectively in preventing ments are now beginning to pay dividends in recurrent cancer. Vigorous testing is already the development of the targeted therapies that underway to apply newer treatments this way. are generating the most excitement. We will see many examples of this appar- Periodically, however, there are articles ent contradiction in coming issues because written in popular magazines critical of the ‘War the same is true of and other on Cancer’. The critics usually have a hard time tumors. In part, we create this confusion for understanding the scope of this large program, VT DeVita, Jr is those who would chronicle our progress, however, and do not specify the criteria used the Editor-in-Chief because the management of various stages to judge the Cancer Program, which leads to of Nature Clinical of different cancers is segmented into various Practice Oncology. an inaccurate description. specialty pockets. One of the main objectives I am reminded of this because two Viewpoints Competing interests of this journal is to put advances in practice in in this issue of the journal on colorectal cancer The author declared context across specialty boundaries. competing intersts; go to the provide good examples of why differences in article online for details. I will revisit the topic of the impact of the US standard treatment practice occur. One recent ‘War on Cancer’ and its critics in forthcoming www.nature.com/clinical practice critic mistakenly saw the ‘War on Cancer’ as doi:10.1038/ncponc0036 issues.

DECEMBER 2004 VOL 1 NO 2 NATURE CLINICAL PRACTICE ONCOLOGY 55

© 2004 Nature Publishing Group