For years, the National Cancer Institute (NCI) has asserted that cancer incidence in the US is on the decline. But a recent scientific study undercuts this claim. It turns out that various flaws and delays in the way the data were reported to the US government created a false impression that progress was being made. In fact, American cancer rates have been rising, not falling, for the most common kinds of cancer.

The reversal of the NCI's erroneous statistics does not come from the medical fringe. It appears in a recent issue of the Journal of the National Cancer Institute (JNCI) itself, written by scientists at the NCI's own Biometry Research Group. It is a reversal with important political implications for the struggling "war on cancer."

The Right Track?
In December 1971, President Nixon launched America's "war on cancer," putting billions of dollars of resources behind a fight to control this dread disease. One obvious measure of progress has been the rate at which cancer afflicts the general population. If the incidence of cancer is rising, then something is obviously wrong with the strategy. If it goes down, however, it implies that effective measures are being implemented for cancer prevention.

In December 1971, President Nixon launched America's "war on cancer," putting billions of dollars of resources behind a fight to control this dread disease. One obvious measure of progress has been the rate at which cancer afflicts the general population. If the incidence of cancer is rising, then something is obviously wrong with the strategy. If it goes down, however, it implies that effective measures are being implemented for cancer prevention.

For years the public has been in a peculiar situation. On the one hand, most people with whom I speak express the conviction that cancer is increasing in frequency among their friends, families and neighbors. On the other hand, almost all medical authorities have reassured us that cancer incidence is in fact declining.

In March 1998, the NCI, American Cancer Society (ACS), and Centers for Disease Control and Prevention (CDC) united to issue an unprecedented joint statement, the so-called "Cancer Report Card." This stated:

"Cancer incidence and death rates for all cancers combined and for most of the top 10 cancer sites declined between 1990 and 1995, reversing an almost 20-year trend of increasing cancer cases and deaths in the United States."

The directors of the three agencies exulted in the seeming progress. "These numbers are the best proof that we're on the right track," said Richard Klausner, MD, then the director of the NCI.

"We must seize the opportunity to build, and build significantly, on this trend," added John R. Seffrin, PhD, chief executive officer of the American Cancer Society.

The implications of these findings were vast. The downturn in cancer incidence was taken as a complete vindication of the government's approach, and, by some, as a refutation of the claims of alternative medicine. After all, if the conventional approach was working, some argued, who needs alternatives?

Elizabeth Whelan, ScD, MPH, a frequent critic of alternative medicine, wrote along these lines in an article on the Quackwatch website. In her words: "The false claim that cancer rates are rising is a favorite of quackery promoters who want to undermine public trust in food companies, drug companies, chemical manufacturers, and the medical profession." Naturally, she drew on the 1998 "Cancer Report Card" as proof that "the incidence and overall death rates from cancer have been declining in the United States."

Not Winning the War
Yet according to an excellent recent article by Sharon Begley of the Wall Street Journal, "America isn't winning the war on cancer after all. Contrary to optimistic reports from the National Cancer Institute showing the incidence of several devastating cancers has leveled off or even declined in recent years, rates for at least some of those cancers have been rising, according to a new analysis by NCI scientists."

Begley added, "More accurate information about cancer rates presents a grimmer picture." She called the revised NCI estimates "a dispiriting picture of the nation's progress in preventing cancer."

Cancer on the Rise
In their reanalysis, the authors of the NCI study reviewed delays and errors in reporting for five common types of cancer. They found that rates of breast cancer among white women, which we were told had remained stable since 1987, actually have been rising by a substantial 0.6 percent per year. The NCI scientists called for more research "to explain the cause for the recent rise in breast cancer incidence."

Lung cancer incidence in women was also purported to be flat, but in actuality it too has been rising, by 1.2 percent a year, since 1996. Melanoma rates in white men were said to be steady or even falling. But now we learn that they have been increasing by a formidable 4.1 percent a year since 1981. Similarly, prostate cancer rates in white men, rather than falling, as we were previously assured, have also been rising by 2.2 percent a year.

"For white men, 1998 prostate cancer rates are actually 12 percent higher than originally reported," wrote Begley, while "for black men they are 14 percent higher." The rate of colon and rectal cancer in white women has been rising 2.8 percent annually since 1996, rather than, as originally calculated, less than 1 percent per year.

Muted Response
When the 1998 "Cancer Report Card" was issued, it was publicized throughout the world by a compliant media. Yet in contrast to the universal hoopla that greeted the release of the 1998 findings, the response to this astonishing new study has been muted.

"Maybe we were a little too eager to declare the effectiveness of our intervention and prevention programs," said the NCI's Brenda Edwards. "This tells us something we didn't know about whether our intervention and prevention programs are working," said a spokesperson for the American Cancer Society. True: it tells us that the interventions are not working!

Two weeks after the study was published in JNCI, I can still find no mention of it at cancer.gov, the NCI's website. Nor could I find any mention of this publication at the websites of Reuters, ABC News, the New York Times, or even Google.com, which monitors 4,000 separate news sources. I find it galling that the Pollyanna-like optimism of 1998 was swallowed whole by the media, while the corrective dose of realism has gone unmentioned. Why do I get the feeling that "the powers that be" like it that way?

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