LEADING ARTICLE: A new war against cancer

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The Independent Online
In 1970, the US President Richard Nixon promised that cancer would be beaten within a decade. This pledge won him votes and diverted vast sums of public and private funds into research. But much of the money was wasted. Worse, Nixon's claims raised unrealistic hopes. Today, cancer remains, after heart disease, the second biggest killer in the Western world: in 1992, more than 163,000 people died from it in the UK alone.

Many people will be understandably sceptical about yesterday's predictions that we are entering a golden age in cancer treatment. The Imperial Cancer Research Fund forecasts that developments in drug therapy, combined with advances in screening and improved medical practice, should cut the death toll by at least a third over the next 25 years.

There is another question mark over the ICRF vision. We are bound to ask: "Who will pay for this revolution?" Only yesterday, Stephen Dorrell, Secretary of State for Health, issued a familiar call for belt-tightening. The National Health Service must, he said, concentrate on setting priorities and spending money more effectively. Many will doubt, given that existing NHS services are already rationed, how we could possibly afford a whole new range of treatments.

Yet, despite Nixon's false dawn and the resources problem, we may indeed be on the verge of victory over one of our greatest health fears. Thanks to advances in genetic research, we will soon arrive at a complete description of the sequence of events which lead to the development of cancerous tumours. It is already possible, for example, to spot benign polyps in the bowel and operate before they have become cancerous. The next step is use genetic technology to identify hallmarks indicating a vulnerability to certain cancers. Likewise, it should be possible to provide immune treatment that will trick the body into recognising and destroying early cancerous cells.

The revolution in genetics also means that drugs are being developed to tackle genetic defects. Drug therapy is already having a dramatic effect in improving survival rates among those with breast cancer. The reorganisation of cancer services into specialist units, announced earlier this year by the Government, promises further incremental cuts in fatalities.

None of these advances will be achieved cheaply. But a revolution in cancer treatment is compatible with the Government's sensible aim of making the NHS more efficient. A cancer spotted early and dealt with quickly will cost less than an illness that requires long periods of radiotherapy, chemotherapy and hospital care.

The crucial lesson of the Nixon era - and the message yesterday from Mr Dorrell - is that the NHS should invest in treatments whose effectiveness has been clearly demonstrated. Too much money is spent on drugs, technology and practices that are of unproven value. Some should be abandoned. With so many new drugs being developed, particularly for cancer, the NHS must also employ rigorous vetting of what is eventually prescribed. That way we just might beat cancer without breaking the NHS in the process.