chapter  Chapter 4
30 Pages

Evaluation of the National Cancer Program and Proposed Reforms

WithSamuel S. Epstein

The National Cancer Institute (NCI) launched the cancer prevention awareness program in 1984 as part of the NCI's overall effort to reduce the rate of cancer mortality to one-half of the 1980 rate. Cancer strikes one in three and kills one in four, up from an incidence of one in four and a mortality of one in five in the 1950s. The discrepancy between incidence and mortality trends probably reflects the overdiagnosis of benign as malignant neoplasms, especially for the breast and prostate. From 1974 to 1987, survival rates increased marginally from 49.1 to 51.1 percent for all ages and races, and decreased from 38.6 to 38.4 percent for blacks. Smoking is indisputably a leading cause of disease and death from cardiovascular disease and lung cancer, and cancers at other sites generally to a much lesser extent. However, the NCI leadership has trivialized the substantial evidence for a major role of occupational and urban causes of lung cancer.