CANCER: THE GOOD NEWS

By Dick Thompson/Washington

In the rush of scientific optimism that followed the polio vaccine and the first moon walk, Richard Nixon declared war on America's second biggest killer: cancer. Twenty-five years and $35 billion later, the news from the cancer front is good and bad.

The good news is that for the first time since 1900, the overall cancer death rates in the U.S. are coming down. According to a report published last week in the journal Cancer, the number of cancer deaths fell from a peak of 135 per 100,000 in 1990 to 130 last year--a 3.1% drop. Even more encouraging, that trend seems to be accelerating. Experts predict that within 20 years, deaths from cancer could easily be cut an additional 25%, and with luck they could be cut in half. As Health Secretary Donna Shalala proudly declared last week, "We are starting to win the war on cancer."

The bad news is that all those billions spent on research into basic science may have had little to do with it. Doctors have still not found a magic bullet against cancer, and it is becoming increasingly clear that they probably never will. Instead, most of the gains reported last week stemmed from such factors as changes in life-style, reduced exposure to chemicals in the workplace and better detection of malignant growths.

The single most important factor in the new cancer statistics--both good and bad--was smoking. Cigarette consumption has dropped sharply in the past 30 years--from 4,194 per capita annually in 1964 to 2,515 today--and the effects of that drop are finally starting to show up. Lung cancers still account for 30% of all cancer deaths, but in those demographic groups that cut back sharply--male Caucasians, for example--lung-cancer death rates have dropped impressively (6.7%). Conversely, a lot of women took up smoking over the same period, which may account for the rise in lung-cancer rates among older women over the past five years (6.4%).

Cancer awareness has paid off as well. Patients are much more conscious today of cancer's early warning signs--and more likely to go in for regular Pap smears and prostate exams. Those tests, meanwhile, have become exquisitely sensitive. Breast cancers, for example, can now be spotted when they are only 2 cm in size, compared with 3 cm a few years ago. "The smaller the cancer," says Harmon Eyre, chief medical officer of the American Cancer Society, "the better the chances of survival."

The good news may be short-lived, however. American teens are taking up tobacco in alarming numbers. Today, 19% of all eighth-graders use tobacco regularly, up from 14% in 1991. By tenth grade, about 28% are smoking. If they keep it up, they can forget about living longer--or healthier--lives.

--By Dick Thompson/Washington