(Bloomberg Opinion) -- President Joe Biden did not use the word “war” to describe his plans for a “cancer moonshot” that aims to “end cancer as we know it.” But his announcement last week quickly drew comparisons to the program launched by President Richard Nixon a little over 50 years ago — known universally as the “war on cancer.” The new initiative also promises to bring the power of the federal government to bear on the deadly disease. Not to be outdone, the British also announced their own “national war on cancer” this past week.
All these martial metaphors, though, have a dubious record of success. For many decades, the war analogy has structured our understanding of cancer in counterproductive ways. This legacy is worth considering as the U.S. prepares to open yet another front in this long-running battle.
In the 1920s, cancer was barely understood and rarely discussed; many believed it was contagious. Few doctors specialized in treating cancer patients. Surgery saved a few, but most people were diagnosed too late to help. Absent treatments, mortality rates remained extremely high.
It was in this void that the American Society for the Control of Cancer — forerunner of the American Cancer Society — sought to raise awareness and funding for research. In 1928, it adopted the “sword of knowledge” as a symbol of their resolve. The press embraced the martial theme. A year later, the Chicago Tribune informed readers: “Radium Called Best Weapon in War on Cancer.”
The battle had begun. In 1938, Marjorie Illig, a leader in the society, founded the “Women's Field Army,” a group that dressed in military-style khaki uniforms, complete with ranks and medals.
These early cancer warriors meant well, working to raise awareness of how early screening and intervention could save lives. But by embracing rhetoric and imagery that framed the struggle as a battle, such efforts inadvertently set in motion approaches to fighting cancer that privileged the idea that cancer cells could and should be exterminated at all costs.
During World War II, military doctors at Yale University began studying something they described in lab notebooks as “Substance X.” Its real name was nitrogen mustard, better known as mustard gas. Though focused on finding antidotes to it on the battlefield, the doctors realized it might be able to kill cancer cells.
In 1942, they treated a terminal cancer patient with an intravenous drip containing the toxin. It worked, sort of: The patient made what looked like a complete recovery. But some cells survived the onslaught. Now resistant to the chemical therapy, they came roaring back. Three months after the initial treatment, the patient died. The outcome was a harbinger of things to come.
Other researchers joined the search for chemical agents that could be used to destroy cancer cells. Jane C. Wright, a pioneering African-American researcher, was one of the first. She demonstrated that methotrexate could drive cancers into temporary remission in some patients. A small but growing cadre of researchers began investigating other promising compounds as well.
These approaches gave many patients time they would never have enjoyed, prolonging their lives by months or even years. But victory proved elusive, despite the development of ever more powerful weapons. One typical account from 1956, for example, described a new form of radiation therapy as a “cobalt bomb ‘charged' for war on cancer.”
In 1959, the New York Times described the search for “new cancer weapons” beyond the “conventional weapons” of surgery and radiation. “Like all wars,” the paper solemnly intoned, “this one has its victories and defeats, sneak attacks, chemical warfare, logistics, and communiques. Though the enemy is retreating on many fronts, he is advancing on others.”
In retrospect, the fixation on characterizing cancer as an enemy beyond ourselves was bizarre. Unlike external threats like smallpox or polio — which could be driven from our environment — cancer was immanent in human biology. Waging a scorched-earth campaign against it meant waging war against our own bodies. This could buy patients time, but it rarely left them fully cured.
There were exceptions to this rule. The use of radiation to cure Hodgkin's disease fueled hopes that treatments might work on other forms of cancer. Researchers had luck with some forms of childhood leukemia, though for the most part, cancer won in the long run. Yet the drive to develop new weapons to destroy cancer cells proceeded apace.
In the process, the most obvious way to combat cancer — prevent it from happening in the first place when possible or screen to catch it earlier — took a backseat. It was far more glamorous to take up arms in the hopes of vanquishing cancer entirely. And in that battle, nothing less than total victory in the form of a complete cure was acceptable.
This idea drove the campaign launched in the late 1960s by socialite Mary Lasker, head of the American Cancer Society's board. In 1969, she began lobbying President Nixon to “cure cancer.” Her ally in this struggle was Dr. Sidney Farber, who — long before Biden's announcement last week — urged the nation to launch a campaign against cancer on the scale of the effort that “went into putting a man on the moon.”
Congress responded with several versions of what became the National Cancer Act, though the original legislation had more warlike names: the National Cancer Attack Act and the Conquest of Cancer Act. Nixon never used the phrase “war on cancer,” but the press and supportive politicians immediately gave the effort that nickname.
The legislation opened the floodgates of federal funding on research. It also marked the canonization of what one paper in Frontiers in Oncology recently described as the “scorched earth, win-at-all-costs ethos” and “war-like cell-kill treatment paradigm” that would come to define the attitude of cancer research over the past 50 years.
While the resulting research reduced mortality for some cancers and jump-started work in other fields, we are far from achieving the victory that Nixon envisioned. Cancer is still the second leading cause of death in the U.S., and is projected to become the top killer in the coming decade. Many cancers remain impossible to cure, and significant racial disparities in treatment meant that whatever the dividends of the “war on cancer,” these have not benefited all Americans equally.
Moreover, the declines in mortality that many advocates point toward as evidence of success have been driven in no small part by better screening and prevention efforts as well as significant reductions in tobacco use. The development of new, more powerful drugs may well be the least important factor in these trends, even if such treatments grab all the headlines.
Given this decidedly mixed record, perhaps it's time to retire the “war on cancer” metaphor, with its insistence on total victory. Of course, some cancer warriors may protest. Fear not. There are other military metaphors more appropriate to our moment. The Cold War offers the best model: containment, which turns cancer into a chronic, but manageable, condition.
This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.
Stephen Mihm, a professor of history at the University of Georgia, is a contributor to Bloomberg Opinion.
©2022 Bloomberg L.P.
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