Twenty-five years after the United States launched an all-out "war on cancer," the incoming president of America's top cancer research organization asks, "What war?"
His question comes despite recent evidence that cancer death rates have finally started to decline after decades in which news from the battlefront was usually discouraging.
Nobody believes more fervently in the cause than Dr. Donald S. Coffey, a Johns Hopkins researcher who decided to commit his life to cancer while meditating beside a bread-wrapping machine in the Tennessee bakery where he once worked.
"See why I'm so excited about all the things happening in the field?" he exclaimed recently, nearly leaping from his chair after describing experimental gene therapies, cancer vaccines and molecular manipulations that might replace the cruder treatments of today.
But Coffey said efforts have been stymied by insufficient funding, leaving many young researchers without the money to pursue imaginative strategies.
"They're calling it a war when I say it's a skirmish," said Coffey, 64, starting one of the impassioned, rhetorical rolls for which he is known.
"I think one-tenth of a penny out of your tax dollar is not enough for something that half the males and a third of the females are going to get and one out of four people are going to die of.
"You're going to have to die of something, but this is not one you want to die from," Coffey said. "I don't want to frighten patients, but this is not pleasant: Severe bone pain that can't always be controlled. Pathological fractures."
He went on, "I don't think we have to hang our heads in shame over the progress that's been made. What we have to hang our heads in shame over is how little money has been put into this.
"I want a real war declared on cancer."
In April, Coffey will start a one-year term as president of the American Association for Cancer Research, an 8,000-member organization dedicated to the exchange of new ideas.
He said one of his primary missions will be to persuade the public -- and the Congress -- that the $2.3 billion in federal money being spent this year on cancer research is not nearly enough.
Cancer is the No. 2 killer after heart disease, claiming more than a half-million victims each year. After almost a century of steady increase, cancer death rates fell between 1991 and 1995.
The overall mortality rate, adjusted for age, dropped each year during the period for a total decline of 2.6 percent.
The largest reductions were among African-Americans, a group that has been hit disproportionately hard by cancer. The decline was steepest among black men, whose rate dropped 8.1 percent, compared with black women, whose rate declined 2.5 percent.
But cancer mortality remains significantly higher among African-Americans than whites. Dr. Richard Klausner, director of the National Cancer Institute, blames the disparity on several factors, including poorer access to care and less aggressive treatment.
"One of the unacceptable facts of our nation's cancer burden is that it is unevenly distributed among our population," Klausner said in this month's Journal of the National Cancer Institute.
Coffey's term comes as scientists and policy-makers are waiting to see whether the decline represents a historical turning point, as Klausner contends, or just a brief downturn.
Tomorrow marks the anniversary of the day President Richard M. Nixon signed legislation to increase federal oversight and funding for cancer research. He promised "an unprecedented attack a great crusade." The president of the American Cancer Society said it would be "the greatest thing ever done by the United States."
In 25 years, the nation has poured $28 billion into research. Half of the money has been spent on basic science -- deciphering the inner workings of cells -- while the rest has gone to treatments and prevention.
Despite the assault, overall cancer deaths rose by 6.3 percent between 1973 and 1992. Huge strides were made against childhood cancers such as leukemia, lymphoma, Hodgkin's disease and testicular cancer.
But statistically, the improvements were overwhelmed by increased deaths from lung and prostate cancers and many other malignancies that strike adults.
The recent gains are modest, but Coffey said the quarter-century performance is really better than one might think. If one sets aside lung cancer deaths -- a big set-aside -- mortality from all other cancers declined 3.4 percent since 1976.
He made that statistical leap for a reason: Lung cancer is, by far, the largest cancer killer. Smoking accounts for nearly all cases but takes decades to trigger the disease. And while the habit has been waning for many years, society has only recently begun to see the reward that matters most -- fewer deaths.
There are several reasons for the progress against other cancers, he said.
He credited better diagnostic procedures -- such as the PSA blood test for prostate cancer -- that enable doctors to catch some tumors early enough to be cured.
He credited environmental and dietary improvements such as cleaner air and the removal of nitrites from foods. And he credited new surgical techniques that allow removal of diseased tissues with fewer side effects.
In many cases, advances came not from breakthroughs but from new ways to use old weapons. Doctors, for instance, have found safer and more effective combinations of chemotherapy drugs long in use.
Cancer is a relentless disease, triggered when genetic changes cause cells to lose their shape and multiply out of control. The cells have an amazing capacity to resist whatever therapy is thrown at them -- hormones, toxic chemotherapy, even radiation. If only one cell is resistant, it can multiply and give a tumor new life.
"Traditional weapons against cancer are maddeningly indiscriminate, killing not just cancer cells but healthy ones as well," he said.
"We need tissue-specific and cancer-specific drugs. And that's what everybody is working on. So you don't lose your hair and your bone marrow when you take them.
"We're trying to make them so they can be given in an outpatient setting, so patients don't have to be hospitalized with all this big-time stuff that knocks out all the systems of your body."
Coffey, who heads the research arm of Hopkins' world-renowned urology department, speaks with the folksy informality of Bristol, Tenn., where his father ran a service station and Coffey could think of no higher goal than to graduate with a business degree from East Tennessee State University.
A dyslexic, he struggled through high school with C's. But Coffey worked hard, earning a college chemistry degree in 1957 after his interests veered in a new direction.
Along the way, he worked in a bakery and a textile mill that made rayon tire cord. It was in the bakery that he got the idea to determine his future through meditation, a technique that he heard was practiced by Native Americans.
"I didn't have anything else to do," he said. "I had to feed this machine like a robot. It was not an easy thing to do. Thinking about not thinking is thinking." But he resolved to meditate for two weeks.
"All of a sudden, I got this overpowering feeling that I should work on cancer. It was like this great big hunch. The thing that struck me was, 'You egomaniac, that's like curing polio.' "
At the state college, a chemistry teacher urged him to pursue graduate work at John Hopkins University. There, he earned a doctorate in physiological chemistry and rose through the faculty to win professorships in urology, oncology and pharmacology.
For all his brilliance, Coffey is comfortable explaining the principles of cancer genetics with metaphors borrowed as often from pop culture as science. When a cell turns cancerous, he said, it's like a juke box that is suddenly wired to play the wrong record.
"The normal cell is doing a minuet, and the cancer cell is doing the jitterbug. It's really unstable. It's playing all sorts of crazy stuff. That's what we're after."
Scientists have made intellectual leaps in the past decade, he said, gaining new understandings of the molecular underpinnings of cancer. They have found genes that predispose people to six major cancers and, experimentally, are trying to cure some cancers with gene therapies.
Some are hoping to beat the disease with vaccines that would stimulate the immune system to attack cancer from within.
"This is one of the hardest biological and medical problems in the world, and we're learning just how tough it is," said Coffey.
"It isn't like we're short of things to do. Now, I'm going to roll up my sleeves and really take after this war. We're going to have a real war on cancer."
Pub Date: 12/22/96