On December 23rd, 1971, just when the US establishment was realising its war in Vietnam was a lost cause, President Richard Nixon declared yet another war - the War Against Cancer. But 27 years on, with billions of dollars spent by a whole army of researchers trying to find a cure, the war on cancer seems to be heading the way of the military campaign in Indochina.
Over the last decade alone, five million Americans have died of the disease, which has become a leading cause of death not only in the US but right across the Western world. With 7,000 deaths from cancer each year, compared with 500 road deaths, the Republic of Ireland would also seem to be on the losing side of this war. While there have been successes on some fronts, for example incidence of stomach and cervical cancers have been declining over several decades, and earlier this month US researchers announced a trial drug with potential for protecting some women from developing breast cancer, these successes need to be placed in an overall context of other cancers increasing to epidemic proportions.
As Samuel Epstein, Professor of Occupational and Environmental Medicine at Illinois University, Chicago, reports in the current issue of the Ecologist journal: "Cancer now strikes one in three people and kills one in four, up from an incidence of one in four and a mortality of one in five in the 1950s." The same rate of incidence is quoted by the Irish Cancer Society.
The increase in cancer can be partly explained by demographic changes. Bigger and older populations tend to show more cancers. But even after this demographic effect is taken into account, there is a more than 40 per cent real increase in the rate at which the disease is striking the Western world over the last four decades. One simple reason why the authorities on both sides of the Atlantic are losing the war against cancer, says Epstein bluntly, is because "they are not even fighting it".
Since the post-war years when cancer first became a major public policy issue, there has developed, what he calls, a "cancer establishment". Included in this establishment are high-profile charitable groups, notably the National Cancer Institute in the US and the Cancer Research Campaign in Britain; multinational pharmaceutical companies with multi-million dollar investments; and a public sector assemblage of thousands of medical researchers serviced by a plethora of equipment companies. The effect of this cancer establishment, Epstein charges, is to fixate attention on drug development, treatment and diagnosis while ignoring research into wider causes of the disease. This bias in effort is lamentable, says Epstein, because a growing amount of evidence suggests that 80 to 90 per cent of all cancers are caused by environmental factors. That is, the vast majority of cancer cases could be prevented.
Take breast cancer, which has become a leading cause of death among women. In the US, 46,000 women now die every year from the disease with an incidence of one in eight today compared with one in 20 in 1940. Over the past two decades, more American women have died from this disease than all Americans in the first and second World Wars, the Korean War and the Vietnam War combined. More than £1 billion has been spent on detection screening and drug development. Yet none of this massive effort has stemmed the tide of breast cancer.
Many studies have shown that when women migrate to the US from countries with low cancer incidence, such as Korea, they rapidly acquire the higher cancer rate of that country. This strongly suggests that the breast cancer problem is largely environmental in origin.
What needs to be done, a number of scientists are beginning to recognise, is for society to take a holistic approach to cancer causation and prevention, with special attention to the environment rather than focusing efforts solely on treatment of individuals and microscopic studies at the cellular level.
"We have got to get serious about prevention," says scientist Ross Hume Hall, at McMaster University, Ontario. But, he says, why we haven't got serious about prevention is because cancer treatment with drugs is "big business". The search for the "magic bullet" cure such as new drugs or cancer genes is a "splendid money generator".
Where cancer prevention initiatives have been implemented, they have usually highlighted "lifestyle factors" such as cigarette smoking, alcohol and dietary choices. There is little doubt that smoking is a significant cause of lung cancer. But critics of the cancer establishment say its emphasis on lifestyle factors serves to "blame the victim" and to obscure wider and possibly more important causes of cancer in the environment.
One of the most worrying trends is the increase in cancers among young children which cannot be easily attributed to lifestyle choices of smoking and alcohol. Since 1950, the incidence of childhood cancers, particularly of the brain, has increased by over 20 per cent. Other cancers to have increased sharply in recent years such as prostate, testicular, non-Hodgkin's lymphona and multiple myeloma seem also unlikely to be connected with smoking or nutritional choice.
Sandra Steingraber in her book Living Down- stream, which is out this week, argues for an ecological approach to cancer. Steingraber, who comes from Tazewell County, Illinois, one of the most polluted areas in North America, catalogues an impressive body of case studies which indicates that increased incidence of various cancers is linked to the overload of industrial chemicals and waste products in our environment. One study carried out in New York in 1993 found that women with higher levels of DDE (a derivative of the pesticide DDT) in their blood were significantly more prone to develop breast cancer. Another study has linked higher cancer rates among US farmers to handling of the herbicide 2,4-D, a chemical which was also widely used by American forces in Vietnam as a crop destroyer and jungle defoliant. Higher rates of the same cancer have been found in US veterans and rural Vietnamese.
Since the second World War, 75,000 different types of synthetic chemicals have been introduced into our air, soil, water, food and bodies, with 1,000 new chemicals added to this stock every year through industrial growth worldwide. These chemicals include pesticides, detergents, solvents and petrochemical by-products. More than 95 per cent of these chemicals have never been tested for cancer-causing (carcinogenic) properties, despite the authorities' claims that new chemicals are stringently tested. Of those chemicals that have been tested, many such as DDT and dioxin, are proven or suspected carcinogens. This situation is intolerable, says Steingraber, because of the "threat to human health created by pollution of the living world".
This view is supported by Dr Philip Michael, founder member of the Irish branch of the International Society of Doctors for the Environment. He says: "It is appalling that people in this country as in many other countries are subjected to pollution from so many dangerous chemicals all for the profit of a few private companies." He fears that without systematic research into environmental causes of cancer and stricter control on industrial chemicals, we are reaping a whirlwind of horrific public health problems of which cancer is but the eye of the storm.
Living Downstream by Sandra Steingraber is published on Thursday by Virago Press, £18.99 in the UK.
Sandra Steingraber will give a public talk, hosted by Trinity Greens and the Irish Women's Environmental Network, on Thursday at 7.30 p.m. in the James Ussher Theatre, Arts Building, Trinity College, Dublin.