A better brand of cancer


ON Mortality Monday, when I have the sonogram, the mammogram and the shakes, there comes a four-minute interval during which I believe I have breast cancer.

"We just want to take a few more pictures on the left side," is what the technician says, and she takes them and bustles off, leaving me to contemplate lumpectomy, mastectomy and chemotherapy until the doctor returns to report that there was some problem with the film and all the little spots are gone, vamoosed, vanished, have a nice year, everything's fine.

I immediately go out and purchase lingerie.

But afterward I remember the thought I had while I waited in my pink paper bolero: better breast than ovarian.

Watching people with AIDS over the last decade, seeing how successfully they could turn illness into sound, fury and government action, cancer survivors have learned to be lobbyists for their disease. Nobody has done this better than those who have had breast cancer, which kills 46,000 women each year.

The National Cancer Institute now spends more for research on breast cancer than for prostate, ovarian, colo-rectal and liver cancers combined. Breast cancer is the second leading cancer killer of women, but it receives twice as much money in the NCI budget as lung cancer, which is No.1.

If that sounds like competitive cancer, it's because it is. With a finite pool of research money -- $2 billion this year at the National Cancer Institute -- choices must be made.

Today those choices have as much to do with petitions and demonstrations as with medicine.

Ovarian cancer killed my mother when she was the age I am today -- hence the annual diagnostic sonogram.

But for that one mad moment at the radiologist's it occurred to me that breast cancer would be the better worst case, not only because the survival rates are better, but also because the attention of the nation is focused on it. Congress wants to fund it. And all because thousands of women who have it have been organized, outspoken and relentless.

There's something wrong with that, with how survivor advocacy has driven research dollars. Not because of the survivors, who are doing precisely what I would do in their place. But because of the obvious absence of a coherent government cancer research funding policy based not on the vagaries of politics but on science.

This reached its nadir when the Army was given $200 million to study breast cancer. That's right -- the Army. Senators wanted to move money from the defense to the domestic budget to pay for more research; when they were foiled, Congress voted overwhelmingly to let the Army become the nation's largest underwriter of breast cancer research.

The problem is that many scientists believe money earmarked for breast cancer isn't the best way to cure it. Some believe that basic research, which will eventually provide the key to many diseases, is being shortchanged in favor of targeted money.

Others believe that breast cancer is already well financed and that increases in research money -- a presidential commission this week asked for $50 million more, to bring the total breast cancer allocation to a half-billion dollars -- have little to do with smart science and everything to do with political attempts to look sensitive to women's issues.

Still others believe that it is simply unfair to focus so much attention and money on one kind of cancer. In theory, I agree.

In practice, I'd find it hard to care about fair. If I had breast cancer, I'd welcome the investment.

We women have good reason to be skeptical of the medical establishment, that great group who brought us research protocols that ignored anyone without a Y chromosome.

But we also have reason to be skeptical of a research agenda that relies so heavily on who makes the most noise and who has the best lobbyists. After all, the voices raised in the future could well be different, and deeper, than our own; the tide of sentiment could turn.

And then we will want precisely what we should have -- a big-picture policy in which, without fear or favor, funding decisions are based on what will yield best results for the future, for all of us, for all our children.

Anna Quindlen is a columnist for the New York Times.

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