In 1971, the United States enacted the National Cancer Act. Twenty-five years later, in November 1996, the National Cancer Institute (NCI) reported that the nation's investment in research is paying off. The cancer death rate in the United States has peaked and, for the first time, begun to fall. This progress is due to improvements in prevention, early detection and diagnosis, and treatment.

More than 7 million Americans are cancer survivors today -- some may be considered cured, others continue to live with cancer.

Cancer survivors are alive today because 25 years of research have given doctors better information and tools to deal with cancer. This has resulted not only in better survival, but also in an improved quality of life.

Because of the more widespread use of early detection methods, many of the most common cancers, such as breast and colon tumors, are being diagnosed at earlier stages, when chances for successful treatment are greater. A more enlightened use of chemotherapy combined with improved surgical and radiation treatments for several cancers is also improving outcome.

America's youth have received the most benefit from this country's investment in cancer research. Scientists have been instrumental in developing better treatments for childhood cancer. Just a couple of decades ago, survival of many childhood cancers was measured in weeks or months. The vast majority of children with cancer now can be cured and grow up to be healthy adults, having children of their own. Today, one of every 1,000 people reaching adulthood is a cured survivor of childhood cancer.

Cancer research has also made dramatic improvements in adult cancer. Mortality for testicular cancer, for example, has declined 66 percent since 1973. Hodgkin's disease, which can strike young adults, was once one of the most feared cancers. Today, the majority of Hodgkin's disease patients can be successfully treated, and most are cured. Mortality is falling for cancers of the colon and rectum, breast, and prostate and gynecologic cancers in women and lung cancer in men.

Much work remains to be done. Death rates for some cancers, notably lung cancer in women and lymphatic cancers in both men and women, continue to rise. And the burden of cancer is not shared equally in our society. For example, African Americans have a 30 percent higher cancer death rate than Caucasians.

Most importantly, research has identified some of the genes that enable cancer's growth and other genes that prevent the growth of cancer cells. This crucial information offers scientists unparalleled opportunities to find new ways to prevent, diagnose, and treat cancer.

New Technologies. The Cancer Genome Anatomy Project. NCI is launching an initiative that will allow scientists to understand intimately the nature of each person's cancer. The Cancer Genome Anatomy Project is designed to define the particular patterns of genetic changes determining the behavior of a particular cancer in an individual -- how fast it grows, whether it will spread, and whether it will respond to treatment. The definition of the nature of a particular cancer could lead to revolutionary approaches to early detection, more accurate diagnosis, and more successful treatment. This knowledge will also reveal more about the causes of cancer, leading to prevention strategies that address identified risks and take advantage of knowledge about how a cancer develops over a period of years.

Better Treatments. NCI has undertaken two major initiatives to improve cancer treatments:

• New drug development will capitalize on recent research advances. For example, scientists are working to see if a virus that grows only in cancer cells will infect and kill tumor cells without harming normal cells. These and other creative potential cancer treatments, such as immunotoxins, antisense technologies, and oncolytic viruses, are being readied or are already being tested in patients.

• An Informatics Initiative will create an information system linking NCI, the Food and Drug Administration (FDA), pharmaceutical companies conducting new cancer treatment studies, all of the nation's cancer centers, and the thousands of hospitals and nearly 10,000 doctors participating in cancer research. This information system will speed up research by enhancing the consistency of reporting study results, and will provide researchers with instant access to the latest data. Enhanced research reporting will, in turn, support FDA's new drug approval process. This Informatics Initiative will also make information about the prevention, detection, and treatment of cancer available to all. It will link with NCI's computerized systems that describe, in user-friendly language, all cancer treatment studies supported by NCI and will provide detailed information for physicians on standard treatment options, as well as on cancer studies.

Most of today's treatments have a major limitation -- the damage they cause to healthy cells. The goal for new drug development is to target only a patient's cancer cells, thereby reducing side effects and improving quality of life.

Greater Access to the Benefits of Research. Cancer patients want quick and easy access to the best, newest treatments available. As a result, NCI is working to give patients in managed care systems that kind of access. The initiative began with an agreement between NCI and the Department of Defense (DoD) under which beneficiaries of DoD's health program can enroll in cancer treatment studies when that is the appropriate treatment choice. Another agreement, with the Department of Veterans Affairs (VA), will strengthen the information, prevention, and treatment choices for eligible patients. NCI is working to bring private care systems under the initiative and help bring the discoveries of medical research to all.

Greater Access to Information About Cancer.

• PDQ Database. Since passage of the National Cancer Act, NCI has created PDQ, a large, comprehensive database of up-to-date descriptions of cancer treatments for patients, the public, physicians, and researchers. Also contained in PDQ is information about cancer studies in which patients can enroll, which is now available through the World Wide Web (http://cancernet.nci.nih.gov). And in a new initiative, NCI, in cooperation with patient groups, is preparing lay-language descriptions of the PDQ cancer studies that are enrolling patients. These descriptions will also be accessible through the World Wide Web.

• Cancer Information Service (CIS). The CIS provides a nationwide telephone service for cancer patients and their families, the public, and health care professionals. The CIS disseminates information on cancer and provides access to PDQ. The toll-free number is 1-800-4-CANCER (1-800-422-6237); services are provided in English and Spanish. People with TTY equipment may call 1-800-332-8615.

Society Working Together. NCI has spearheaded partnerships within all segments of our society to address the cancer problem and make research discoveries available to everyone. People from all sectors of society -- teachers, businessmen, civil servants, scientists, doctors, nurses, patients, and patient advocates -- are working to confront issues like tobacco control, cancer care, environmental safety regulations, and many other societal issues. They will be brought together under a new initiative proposed and supported by NCI and carried out by the National Academy of Sciences. This initiative, known as the National Cancer Policy Board, will provide a forum where representatives from the diverse groups participating in the nation's cancer effort can debate policy and make recommendations for cancer policy affecting the nation. This Board will go beyond research and look at societal issues, such as smoking control and the conduct of cancer treatment studies in managed care settings.

Scientific American, Special Issue: What You Need to Know About Cancer, September 1996.