Despite earlier diagnosis and better treatment, cancer remains one of the leading causes of death in Western-type countries. In fact, both cancer incidence and mortality rates have steadily increased over the years. Yet, cancer treatment has saved many lives, and continues to improve.
Surgery is the most important cancer treatment method and the key to survival, followed by radiation therapy. The latter's detrimental side effects have been reduced by a better comprehension of normal tissue tolerance to radiation and the availability of more powerful linear accelerators. The last major breakthrough with anti-cancer drugs came three decades ago: cisplatin significantly improves the cure rate for testis cancer. Immunotherapy has offered modest or little benefit, apart from a small proportion of patients with mestatic cancer of the kidney or melanoma. It has been suggested that gene therapy may follow the same path since it appears unlikely that one or a few genes transected into a few cancer cells will be able to reverse the malignant phenotype. The development of resistant cells at initial presentation or during relapse has undermined the use of chemotherapeutic drugs in the treatment of hematologic malignancies and solid tumors. Such acquired resistance to treatment also occurs in hormonotherapy and immunotherapy. Research has led to substantial advances in the understanding of the processes of cancer.
Earlier diagnosis and improved treatment methods have failed to reduce growing cancer mortality rates in Western countries. Given this, cancer prevention should be emphasized.
In 1997, The New England Journal of Medicine, cancer researchers summed the situation up like this: The medical approach to cancer is a qualified failure and we call for a shift in worldwide cancer research from treatment to prevention. Many billions of dollars have been poured into finding improved cancer treatments, but all that effort has lead virtually nowhere. We've given it our very best scientific talent, and it just hasn't worked. It's time to recognize it hasn't worked, and get serious about prevention.