We Fought Cancer…And Cancer Won.

The meager progress has not been for lack of trying. Since 1971, the federal government, private foundations and companies have spent roughly $200 billion on the quest for cures. That money has bought us an estimated 1.5 million scientific papers, containing an extraordinary amount of knowledge about the basic biology of cancer. It has also brought real progress on a number of fronts, not least the invention of drugs for nausea, bowel problems and other side effects of the disease or treatment. "These have reduced suffering and changed people's ability to live with cancer," says Mulvey. In fact, just a few months after Nixon's call to arms, Bernard Fisher of the University of Pittsburgh began studies that would show that a woman with breast cancer has just as good a chance of survival if she receives a mastectomy rather than have her breast, chest-wall muscles and underarm tissue cut out, the standard at the time. The new approach spared millions of women pain and disfigurement. In 1985, treatment improved again when Fisher showed that lumpectomy followed by radiation to kill lingering cells was just as effective for many women as mastectomy. It wasn't a cure, but it mattered. "One can wait for the home run," says Fisher, now 90, "but sometimes you get runs by hitting singles and doubles. We haven't hit a home run yet; we can't completely prevent or completely cure breast cancer."

Nixon didn't issue his call to arms in order to reduce disfigurement, however. The goal was "to find a cure for cancer." And on that score, there are some bright spots. From 1975 to 2005, death rates from breast cancer fell from 31 to 24 per 100,000 people, due to earlier detection as well as more-effective treatment. Mortality from colorectal cancer fell from 28 to 17 per 100,000 people, due to better chemotherapy and, even more, to screening: when colonoscopy finds precancerous polyps, they can be snipped out before they become malignant.

But progress has been wildly uneven. The death rate from lung cancer rose from 43 to 53 per 100,000 people from 1975 to 2005. The death rate from melanoma rose nearly 30 percent. Liver and bile-duct cancer? The death rate has almost doubled, from 2.8 to 5.3 per 100,000. Pancreatic cancer? Up from 10.7 to 10.8. Perhaps the most sobering statistic has nothing to do with cancer, but with the nation's leading killer, cardiovascular disease. Thanks to a decline in smoking, better ways to control hypertension and cholesterol and better acute care, its age-adjusted mortality has fallen 70 percent in the same period when the overall mortality rate from cancer has fallen 7.5 percent. No wonder cancer "is commonly viewed as, at best, minimally controlled by modern medicine, especially when compared with other major diseases," wrote Harold Varmus, former director of NCI and now president of Memorial Sloan-Kettering Cancer Center in New York, in 2006.

About all scientists knew about cancer 50 years ago was that cancer cells make copies of their DNA and then of themselves more rapidly than most normal cells do. In the 1940s, Sidney Farber, a Boston oncologist, intuited that since cells need a biochemical called folate to synthesize new DNA, an anti-folate might impede this synthesis. After a friend at a chemical company synthesized an anti-folate—it was named methotrexate—Farber gave it to cancer patients, sending some into short-term remission, he reported in 1948. (Two years earlier, scientists had serendipitously discovered that mustard gas, a chemical weapon, could reduce tumors in patients with non-Hodgkin's lymphoma, but no one had any idea how it worked.) Thus was born the era of chemotherapy, one that continues today. It is still based on the simple notion that disrupting DNA replication and cell division will halt cancer. Soon there would be dozens of chemo drugs that target one or more of the steps leading to cell proliferation. Almost all of those approved in the 1970s, 1980s and 1990s were the intellectual descendants of Farber's strategy of stopping cancer cells from making copies of their DNA, and then themselves, by throwing a biochemical wrench into any of the steps involved in those processes. And none of it had anything to do with understanding why cancer cells were demons of proliferation. "The clinical-research community was expending enormous effort mixing and matching chemotherapy drugs," recalls Dennis Slamon, who began a fellowship in oncology at UCLA in 1979 and is now director of clinical/translational research at the Jonsson Cancer Center there. "There was nothing coming out of the basic science that could help" patients.

In the high-powered labs funded by the war on cancer, molecular biologists thought they could change that. By discovering how genetic and other changes let cancer cells multiply like frisky rabbits, they reasoned, they could find ways to stop the revved-up replication at its source. That promised to be more effective, and easier on healthy cells than chemotherapy drugs, which also kill normal dividing cells, notably in the gut, bone marrow, mouth and hair follicles. In the 1970s, cancer scientists discovered cancer viruses that alter DNA in animals, and for a while the idea that viruses cause cancer in people, too, was all the rage. (The human papilloma virus causes cervical cancer, but other human cancers have nothing to do with viruses, it would turn out.) In the 1970s and 1980s they discovered human genes that, when mutated, trigger or promote cancer, as well as tumor suppressor genes that, when healthy, do as their name implies but when damaged release the brakes on pathways leading to cancer.

It made for a lot of elegant science and important research papers. But it "all seemed to have little or no impact on the methods used by clinicians to diagnose and treat cancers," wrote Varmus. Basic-science studies of the mechanisms leading to cancer and efforts to control cancer, he observed, "often seemed to inhabit separate worlds." Indeed, it is possible (and common) for cancer researchers to achieve extraordinary acclaim and success, measured by grants, awards, professorships and papers in leading journals, without ever helping a single patient gain a single extra day of life. There is no pressure within science to make that happen. It is no coincidence that the ratio of useful therapy per basic discovery is abysmal. For other diseases, about 20 percent of new compounds arising from basic biological discoveries are eventually approved as new drugs by the FDA. For cancer, only 8 percent are.