Combatting the Crab

"The Crab loves people. Once he's grabbed you with his pincers, he won't let go until you croak."

Spoken by a cynical patient in Alexander Solzhenitsyn's Cancer Ward, the statement conveys the fatalism that many people feel about the congeries of diseases called cancer. One out of every four Americans can expect to develop the disease during his lifetime. Despite this toll, there is evidence that the crab's grip is at last being loosened.

As physicians and researchers gathered in Los Angeles last week for the seventh National Cancer Conference sponsored by the American Cancer Society and National Cancer Institute, the NCI reported new figures showing that chances of surviving cancer have improved significantly in the past 30 years. In 1940 only one out of five patients found to have cancer could be expected to live for five years. Now about a third will survive at least that long, and the rate is improving rapidly.

Based on a study of white patients diagnosed between 1940 and 1969 in 100 hospitals throughout the country, the 217-page report contains bad news for victims of lung and pancreatic tumors. Lung cancer remains the most common type of the disease among men; the survival rate is poor and the incidence of the ailment is increasing. Life expectancy for patients with pancreatic cancers has shown almost no improvement, and this kind of tumor is becoming more common.

The experts are uncertain why some varieties have yielded so little to new treatment methods, but the contrast between pancreatic cancers and many other types is startling. The three-year survival rate for patients with bladder cancer increased from 48% to 62% during the period covered by the study; for breast cancer, from 63% to 72%; for cancer of the cervix, from 53% to 63%. Improvements were also shown for cancers of the thyroid, prostate, larynx, brain, skin and bone.

Defense Mechanism. The most dramatic progress has occurred in leukemia, a cancer of the blood-forming tissues that strikes particularly hard at children, accounting for at least a third of all cancer victims under 15. Until 1949, only 4% of acute leukemia's victims survived for three years. During the period between 1965 and 1969, this figure climbed to 30%. Now, Dr. William Thurman of the University of Virginia School of Medicine told the conference, more than half those treated with a variety of drugs at children's medical centers are alive and free of disease five years after diagnosis.

The NCI report attributes such reductions in mortality to several factors.

Earlier diagnosis, which enables prompt surgical treatment, is credited with reducing fatalities in cases of breast, cervical, prostatic and rectal cancers. The chemotherapeutic approach, in which drugs are administered in series or in combination, is being used with encouraging results against Hodgkin's disease, a cancer of the lymphatic system, and other systemic cancers.

Even more promising is immunotherapy, or stimulation of the body's own defense mechanisms. In one of a number of attempts to apply this approach to cancer, Dr. Loren Humphrey of the University of Kansas Medical Center has inoculated patients suffering from malignant melanoma, a virulent and fast-spreading systemic cancer, with white cells from people who have suffered the disease. At least a quarter of the patients treated in this way have responded with immune reactions.

Doctors do not expect any of the experimental approaches now under investigation to yield a cure for all kinds of cancer. But most are confident that mortality rates for the disease will continue to drop. Dr. R. Lee Clark, a member of the board charged by the President with developing a national plan to combat cancer, predicts that wider application of known treatments could reduce the overall cancer death rate between 15% and 25% in the next five years. Only one out of every three patients can now expect to live five years after diagnosis. If Clark's prediction is accurate, more than half could look forward to survival for that long.

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