Samuel S. Epstein, MD

At a highly publicized March 12, 1998, Washington, DC press briefing, the National Cancer Institute (NCI) and American Cancer Society (the cancer establishment), together with the Centers for Disease Control and Prevention, released a "Report Card" announcing the recent reversal of "an almost 20-year trend of increasing cancer cases and death," as detailed in the March 15 issue of the journal Cancer. "These numbers are the first proof that we are on the right track," enthused NCI director Dr. Richard Klausner. This news received extensive and uncritical nation-wide media coverage.

These claims were based on a comparison between NCI’s published statistics for 1973-1990 and 1973-1995. However, the more recent information remains unpublished and, according to senior NCI statistician Dr. Lynn Ries, is still being analyzed. More importantly, a critical review of the Cancer publication is hardly reassuring. The claimed reversal in overall mortality rates is not only minimal but exaggerated. It is largely due to a reduction in lung cancer deaths from smoking in men, reflecting personal lifestyle choices, and to improved access to health care rather than to any improvements in treatment and survival rates. Additionally, any true decline would be considerably less if the mortality rates were appropriately based on the current age distribution of the U.S. population, rather than that of 1970, with its relatively higher representation of younger age groups, as misleadingly calculated by NCI. These criticisms are in general consistent with those detailed in a May 1997 New England Journal of Medicine article, "Cancer Undefeated," by former NCI epidemiologist Dr. John Bailar.

. . . a critical review of the Cancer publication is hardly reassuring. The claimed reversal in overall mortality rates is not only minimal but exaggerated.

The claimed reversal in the incidence of cancers of "all sites" is minimal and statistically insignificant, as are similar claims for leukemia and prostate cancer. Even this minimal reduction of prostate cancer is highly questionable as admitted by Report Card authors: "The decreased incidence rates [of prostate cancer] may be the result of decreased utilization of PSA [prostate specific antigen] screening tests . . . during the early 1990’s." While there were significant reductions in the incidence of lung, colon/rectum and bladder cancers, there were significant and sharp increases in uterine cancer, melanoma, and non-Hodgkin’s lymphoma. Moreover, there was no decline in breast cancer rates, which remain unchanged at their current high level. Curiously, no reference at all was made to testicular cancer in young adults nor to childhood cancer, whose rates have dramatically increased in recent decades.

The Report Card apart, there are disturbing questions on the reliability of NCI’s incidence statistics. This is well illustrated by wild reported variations since 1973 for the percent changes in the incidence of childhood cancer: 

The Report Card’s optimistic and misleading assurances, the latest in a series of smoke and mirror break-throughs since 1971 when President Nixon launched the "War Against Cancer," are designed to divert attention from the escalating incidence of cancer, which has reached epidemic proportions. Cancer now strikes 1 in 2 men and 1 in 3 women, up from an incidence of 1 in 4 a few decades ago. Meanwhile, our ability to treat and cure most cancer, apart from relatively infrequent cancers particularly those of children, remains virtually unchanged. The Report Card is also designed to neutralize criticism of NCI’s intransigent fixation on diagnosis, treatment, and basic genetic research, coupled with indifference to prevention, which receives minimal priorities and resources—less than 5% of NCI’s budget. Further illustrative is the fact that NCI has never testified before Congress or regulatory agencies on the substantial published evidence on the wide range of carcinogenic industrial contaminants of air, water, the workplace, and consumer products—food, household products, and cosmetics—and on the need to prevent such avoidable and involuntary exposures. Nor has NCI recognized the public’s right-to-know of such critical information, which plays a major role in escalating cancer rates, nor have they developed community outreach prevention programs. Finally, the Report Card is designed to further buttress aggressive lobbying by the cancer establishment and cancer drug industry for a major increase in NCI’s budget from the current $2.6 billion, up from $223 million in 1971, to the requested $3.2 billion in 1999.

Rather than increasing NCI’s bloated budget, drastic reforms are needed to explicitly re-orient its mission and priorities to cancer causes and prevention.