America is on the verge of committing unprecedented public funds in a new war aimed at eradicating cancer.
President Barack Obama has pledged to find a cure for the disease, funded with billions of dollars from the economic stimulus package, echoing the former president Richard Nixon's "war on cancer", announced in 1971 in the wake of the moon landings. At the same time, the British charity Cancer Research UK is rolling out 20 centres of excellence around the country in a £1.5bn, five-year programme aimed at tackling hard-to-treat cancers with the lowest survival rates.
Harpal Kumar, its chief executive, said: "Cancer research is at the dawn of a golden era. Survival rates have improved for almost all of the common cancers. But there are still major challenges. We need an arsenal of weapons to target individual cancers, and this is becoming a reality." The economic stimulus package announced by Mr Obama includes a huge $10bn infusion over two years for the National Institute of Health, of which $1.26bn is expected to go for cancer research, an increase in federal funding of a third.
Mr Obama will hope he has more success than Mr Nixon. Fired up by the success of the moon landings, the former president committed hundreds of millions of dollars to cancer research in the expectation that science could conquer the disease as it had conquered space. Institutes were established, scientists hired and laboratories built. Yet almost 40 years later, cancer remains one of the West's biggest killers. In the US, according to a gloomy analysis in The New York Times, cancer death rates have fallen just 5 per cent since the 1950s, compared with a 64 per cent fall in heart disease mortality and a 74 per cent decline in the death rate for stroke.
Figures for the UK reveal a similar picture. There was a 17 per cent fall in the cancer death rate between 1977 (the earliest year in which national statistics were collected) and 2006, compared with a 60 per cent fall in the death rate for heart disease and stroke among people under 75.
Cancer Research UK said this did not reflect the real gains seen in cancer treatment. Survival rates have doubled in the past 30 years, with almost half of cancer patients now living for five years. Breast cancer has a 20-year survival rate of nearly 70 per cent and testicular cancer, melanoma (the severest form of skin cancer) and Hodgkin's disease have 10-year survival rates of more than 80 per cent.
But patients with other cancers have fared much worse. Lung cancer, pancreatic cancer and oesophageal cancer have five-year survival rates of less than 5 per cent.
The first three centres of excellence funded by the charity in its £300m-a-year programme are to be located in Liverpool, Birmingham and Belfast – with 17 more to follow.
The need is immense. More than 200,000 people in the UK will be diagnosed with cancer this year, and nearly 1.5 million in the US. They will join millions more living with a disease which is frightening, distressing, and expensive for patients, their families and the wider economy – the overall cost is estimated to be $200bn in the US.
Mr Obama knows the toll cancer of families. His mother died from ovarian cancer in her early 50s and his grandfather had prostate cancer. Speaking about his economic recovery plan, the President said: "It will launch a new effort to conquer a disease that has touched the life of nearly every American, including me, by seeking a cure for cancer in our time."
Can his plan deliver, where Nixon's failed? Mr Nixon promised that cancer would be cured by 1976 to mark the country's bicentennial. It didn't happen. In 1986, Vincent DeVita, head of the National Cancer Institute, promised that if his budget was doubled he would halve cancer mortality by the millennium. He got the money but cancer death rates remained high.
His successor, Andrew von Eschenbach, said in 2003 that his aim was to "eliminate suffering and death" caused by cancer by 2015. Few scientists, if any, think that pledge will now be met.
The failure of Mr Nixon's war to deliver a cure obscured the fact that most people were dying not because of a lack of scientific progress but because of a failure to apply what was already known – basic facts about the value of chemotherapy and radiotherapy. Many of the big advances, such as the discovery of tamoxifen, which has extended the lives of millions of women with breast cancer, were made more than 40 years ago.
Improvements in care have had a much greater impact on the death rate for most cancers than advances in treatment. A cancer caught early is easier to treat, and having a cancer specialist administer the treatment is more effective than a general surgeon.
The breast cancer death rate has seen one of the sharpest declines for any cancer over the last 20 years. In 1990, 2.5 per cent of women died before the age of 70 from breast cancer in the UK – compared with 1.5 per cent in 2006. Earlier diagnosis, aided by screening, and faster treatment have been key to this success.
Big falls in lung cancer in recent years are due to the fall in smoking, which has declined rapidly among men in the last 40 years and more recently in women. Stomach cancer rates have come down by 85 per cent since the 1930s as diets have improved, with more fresh food and less preserved in salt.
These gains have been achieved as a result of changes in lifestyle and the environment that have prevented cancers developing. Gains from advances in treatment have in most cases been insignificant beside these. Yet far less is invested by cancer research organisations in prevention than in seeking new treatments.
In his 1971 State of the Union address, Nixon launched his campaign to cure cancer saying: "The time has come in America when the same kind of concentrated effort that spilt the atom and took man to the moon should be turned towards conquering this dread disease." A generation on, researchers hope they can make his promise real.