ALEXANDRIA, VaSince she founded the Cancer Research Foundation
of American (CRFA) in 1985, the year after her fathers death
from head and neck cancer, Carolyn Bo Aldigé has
become a persuasive and respected advocate for cancer prevention.
On Capitol Hill and within the Executive Branch, she has vigorously
preached the message that cancer often can be prevented. CRFA has
funded prevention research by more than 200 scientists at some 100
In addition to serving as CRFA president, Ms. Aldigé is in her
second consecutive term as president of the National Coalition for
In this interview with Patrick Young, ONIs Washington Bureau
Chief, Ms. Aldigé examines cancer prevention past, present,
ONI: What has changed in cancer prevention since you formed CFRA?
MS. ALDIGE: One thing that has changed is the public perception of
the fact that cancer is a preventable disease. That is much more
widely understood now. If 15 years ago you said cancer and prevention
in the same sentence, people thought you were crazy. There was a
mindset in 1985 that cancer was something you either got or
didnt get. A lot of people understood that smoking was related
to several kinds of cancer, but, beyond that, very little was known
about cancer as a preventable disease.
ONI: This was true of both physicians and the public?
MS. ALDIGE: Absolutely.
ONI: What has happened in the intervening 15 years?
MS. ALDIGE: One is advocacyorganizations such as ours that have
started spreading this message at the grassroots that cancer is a
preventable disease and that there are great strides being made in
cancer prevention research.
We know more about the correct recommendations to make to people with
regard to measures that they can take, both for primary prevention,
meaning not getting cancer in the first place, and for secondary
prevention, which is cancer screening.
We have gone through a phase of gathering information and conducting
scientific studies in the area of chemoprevention, which was
established as a field only in the early 1980s. Today, we understand
why we say you should eat five fruits and vegetables daily.
Another thing that has changed is that we now understand prevention
much more at a molecular level. We are learning how to intervene much
earlier in the process because we know where the process can be
interrupted at the molecular level. That leads to prevention, because
precancerous conditions are being picked up before they can develop
ONI: What are some examples?
MS. ALDIGE: We have funded a study at the Fox Chase Cancer Center
that is looking into the possibility of using calcium as a preventive
agent early on in women who are genetically susceptible to breast
We have funded a lot of studies in the area of COX-2 inhibitors
because there is great evidence to show that COX-2 is highly
implicated in the carcinogenic process. If you can identify
inhibitors of COX-2, you can use them in the treatment of
That is what we are really doing nowlearning to treat
premalignant lesions. There is going to be a paradigm shift in our
thinking about prevention. We will probably stop using the word
chemopre-vention and start talking about the treatment of
ONI: What do you see as major prevention advances in the first
decade of the 21st century?
MS. ALDIGE: We will learn more and more about early intervention. We
will be able to design therapies that will prevent cancer rather than
just treat it.
Tamoxifen [Nolvadex] is, of course, the prime example of that.
Celebrex [celecoxib, a COX-2 inhibitor] didnt prevent cancer in
a clinical trialthat wasnt an endpointbut it helped
to reduce the number of polyps among patients with familial
Those are two examples of what we now call
chemopreventiontreatment for premalignant lesions. There will
be many more of those agents brought to market over the next decade.
ONI: Strong efforts have been made to try to prevent smoking, yet we
have this ongoing increase among young adults. [See State
of the Union on Youth Smoking.]
MS. ALDIGE: And that is awful. But I maintain that the reason teenage
girls smoke is for weight control. This is a society that is obsessed
with thinness while, paradoxically, a huge proportion of its children
are obese. Children are making the decision to smoke by about age 10.
They have decided that it is a cool thing to do when they get old
enough to be able to get cigarettes. At age 10, parents still are a
very strong influence on a childs decision. Children who grow
up in nonsmoking households are much less likely to take it up.
ONI: Why do we seem to be failing to engage more people in self-prevention?
MS. ALDIGE: Because old habits die hard. We need to do a better job
in the whole behavioral science area and to fund more innovative
approaches to behavior changes. Although it may be difficult to
change habits, it is not impossible. We have to do a better job at
educating the public and opinion leaders about what changes we need
If people would simply follow the recommendations with regard to
smoking, diet, exercise, sun exposure, alcohol use, and sexual
practices, and follow recommended screening guidelines, we could
eliminate about 70% of cancers.
ONI: Are physicians reluctant to push patients toward
MS. ALDIGE: In many cases, and this may be an error of omission as
well as commission. I have seen many studies where the single reason
women cite for not getting a mammogram is that my doctor
didnt tell me to. That is also the case with colon cancer
screening. With breast cancer, we can only detect a tumor in the
earliest stages, but with colon cancer, we can detect and eliminate
conditions that have not yet progressed to cancer. We are really able
to prevent colon cancer. Yet the screening rates for it are just abysmal.
ONI: What cancer prevention issues do you expect Congress to
address this year?
MS. ALDIGE: I would like to see a larger share of the NCI budget
dedicated to prevention, and it is important to increase the size of
the CDC budget as well because the real efforts at cancer control are
coming from the CDC. Its the CDC that moves research into
applications that help people prevent cancer.
ONI: Are Congress and the Clinton Administration willing to fund
programs for effective prevention measures, such as widespread
colorectal cancer screening for the disadvantaged?
MS. ALDIGE: As we educate them about the potential of prevention,
more and more will become our allies in the effort, as opposed to
devoting so much of our resources into ever more sophisticated treatments.
ONI: Would you support cutting back on some basic research and
providing the money to prevention efforts?
MS. ALDIGE: I would like to increase the pie for everyone. When you
say basic research, you really arent excluding prevention
because a lot of prevention research is done at the basic science level.
ONI: What are your final thoughts?
MS. ALDIGE: People must understand that habits developed over a
lifetime can reduce ones risk of contracting cancer. The most
difficult part of it all is to motivate people to change behavior.
That is really the challenge. We need to teach our children early how
to make the right choices so that, as they grow and mature, they will
have these habits ingrained.