title: The crisis in U.S. and international cancer policy.
abstract: The incidence of cancer in the United States and other major industrialized nations has escalated to epidemic proportions over recent decades, and greater increases are expected. While smoking is the single largest cause of cancer, the incidence of childhood cancers and a wide range of predominantly non-smoking-related cancers in men and women has increased greatly. This modern epidemic does not reflect lack of resources of the U.S. cancer establishment, the National Cancer Institute and American Cancer Society; the NCI budget has increased 20-fold since passage of the 1971 National Cancer Act, while funding for research and public information on primary prevention remains minimal. The cancer establishment bears major responsibility for the cancer epidemic, due to its overwhelming fixation on damage control--screening, diagnosis, treatment, and related molecular research--and indifference to preventing a wide range of avoidable causes of cancer, other than faulty lifestyle, particularly smoking. This mindset is based on a discredited 1981 report by a prominent pro-industry epidemiologist, guesstimating that environmental and occupational exposures were responsible for only 5 percent of cancer mortality, even though a prior chemical industry report admitted that 20 percent was occupational in origin. This report still dominates public policy, despite overwhelming contrary scientific evidence on avoidable causes of cancer from involuntary exposures to a wide range of environmental carcinogens. Since 1998, the ACS has been planning to gain control of national cancer policy, now under federal authority. These plans, developed behind closed doors and under conditions of nontransparency, with recent well-intentioned but mistaken bipartisan Congressional support, pose a major and poorly reversible threat to cancer prevention and to winning the losing war against cancer.
authors.affiliation: University of Illinois School of Public Health, Chicago 60612, USA. epstein@uic.edu
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Epstein
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Ashford
authors.forename: Brent
authors.initials: B
authors.lastname: Blackwelder
authors.forename: Barry
authors.initials: B
authors.lastname: Castleman
authors.forename: Gary
authors.initials: G
authors.lastname: Cohen
authors.forename: Edward
authors.initials: E
authors.lastname: Goldsmith
authors.forename: Anthony
authors.initials: A
authors.lastname: Mazzocchi
authors.forename: Quentin D
authors.initials: QD
authors.lastname: Young
mesh_terms: D019049:Developed Countries; D004781:Environmental Exposure; D005260:Female; D006291:Health Policy; D006801:Humans; D015994:Incidence; D007391:International Cooperation; D008019:Life Style; D009369:Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D011322:Primary Prevention; D012309:Risk-Taking; D012907:Smoking / Q000009:adverse effects; D014481:United States / Q000453:epidemiology