The war against cancer has been lost

It is remarkable that the bulk of cancer research spending is still going on basic research

Everybody gives money for cancer research. Fighting our most feared disease is the most popular charitable cause in Britain, far outranking charities for children, conservation and the Third World. Cancer Research UK, Britain's largest cancer charity, has 30,000 volunteers, one million regular givers, and invested £191m in supporting scientists last year. These are big numbers, but are they delivering results?

The answer is no. If you examine what cancer research has delivered over the past decades, it is surprisingly little. Thirty years after the then US President Richard Nixon famously launched a "war on cancer" and committed billions of dollars to finding a cure, cancer is still the Western world's biggest killer. Even though death rates have been falling in recent years, the disease still kills more people than it did in 1970.

Despite some spectacular successes against rarer cancers and those affecting children, the war against cancer is being lost. The incidence of the disease is rising, independently of the ageing of the population. In 2000, there were 112,000 new cases of cancer registered, 2,700 more than in 1999.

Research over the last three decades has contributed almost nothing to defeating the major cancers - lung, bowel, breast and prostate - which together account for almost half (46 per cent) of cancer deaths. Such progress as has been made has been due either to lifestyle changes - stopping smoking - or to discoveries made over three decades ago - such as tamoxifen for breast cancer.

The attitude of the cancer research establishment can be compared to that of the First World War general who declared: "Casualties: huge. Ground gained: negligible. Conclusion: press on."

Professor Alex Markham is about to take over as the £150,000-a-year head of Cancer Research UK. Last year, the charitable group which he will lead raised £306m, up 9 per cent on the previous year. That is an impressive performance, given that the organisation was only created in February 2002 from the merger of the Cancer Research Campaign and the Imperial Cancer Research Fund. But will that money be spent for the benefit of patients - or for the benefit of the scientists whom the charity supports?

In his first press conference last week, Professor Markham predicted that cancer would be brought under control "within two generations". It is a familiar boast. Three years ago, the cancer Research Campaign claimed on the first working day of the new millennium (4 January 2000) that an "end to cancer was in sight" and that new treatments would see the disease beaten in 50 years.

The head of any charity has to keep the collecting tins rattling, and that means every advance, however small, is trumpeted as a breakthrough. Professor Markham hedged his bets by suggesting a mix of "early detection, improved treatments and effective prevention messages" would see the disease tamed. But, strikingly, in his presentation he focused exclusively on the first of these - early detection by screening.

This is surprising, as a glance at the charity's own Scientific Yearbook shows that just 6 per cent of its funds were directed at "early detection, diagnosis and prognosis". Over four times as much was spent on developing new treatments (25 per cent) and a whopping 39 per cent went on biological research, understanding the basic mechanisms of cancer.

It is remarkable that three decades since Nixon's war cry, the bulk of cancer research spending, on both sides of the Atlantic, is still going on basic research. In the UK, taking all charitable, NHS and pharmaceutical industry funding together, it is estimated that between £450m and £500m a year is being spent seeking a cure for cancer, of which perhaps £200m is going on research into the biology of the disease.

When you ask scientists if we have had value for money out of all this cash - at least £50bn in the UK alone over the past three decades - they grow bashful. Sir Paul Nurse, the former chief executive of Cancer Research UK and a Nobel prizewinner, said: "Cancer is enormously complicated. The problem was totally underestimated by Richard Nixon. Cancer comprises over 200 diseases, not one."

There is one exception to the general picture of poor results for basic research - a drug called Glivec, recently licensed for the treatment of leukaemia. It is constantly cited in response to questions about what research has yielded as an example of a new kind of cancer drug that heralds a new era in cancer treatment. Glivec is unique because it was developed from first principles based on an understanding of cell mechanisms. Previous cancer drugs have been discovered by trial and error rather than building them up, piece by piece.

Drugs, however, are not the answer to cancer. In an ageing population, in which one in every two of us is likely to develop cancer before we die, the priority must lie with prevention. At least two thirds of cancers are thought to be caused by environmental and lifestyle factors, such as diet and smoking.

Stomach cancer rates have fallen by 85 per cent since the 1930s as diets have improved to include more fresh food and less food preserved in salt. Over the same period there has been an explosion in deaths due to smoking. Gains from treatment are insignificant beside those changes.

The big advances in the next 10 or 20 years will come in prevention and early detection as they have in the last 10 or 20 years, according to Nicholas Day, professor of public health at Cambridge University. But spending on prevention accounts for just 2 per cent of all money spent on cancer research.

Part of the reason is that prevention lacks the glamour of research into the biology of cancer or new treatments for it. Sir Paul Nurse won the Nobel prize for his work on the cell cycle, but Sir Richard Doll, the man who established the link between smoking and lung cancer, thereby saving millions of lives, has not.

Last year, for the first time, the cancer charities and government organisations collaborated to establish an umbrella body, the National Cancer Research Institute, and publish a map showing where the money for cancer research was being spent. The aim was to avoid duplication of effort and to ensure that every pound given is spent to best effect.

The findings contained some surprises. Breast cancer takes almost 18 per cent of research funding - the highest proportion for any cancer, and testimony to the lobbying power of the breast cancer charities - but accounts for 8 per cent of deaths. Lung cancer attracts 3 per cent of research spending but accounts for 22 per cent of deaths. Nobody loves a smoker - especially an elderly, poor, sick one who may be seen to have brought his illness (it is mostly men) on himself. But what the map also showed was the dearth of spending on prevention.

When Professor Markham takes over as chairman of the National Cancer Research Institute, his first task should be to re-examine the research priorities, not only of his own organisation but of all those in the cancer field. The cancer establishment should spend less on basic research and more on early detection and prevention if we are to be persuaded to keep their collecting tins rattling.

j.laurance@independent.co.uk