BETHESDA, MdAn independent committee studying the status of the
National Cancer Program plans to release its report in January, the
month that a new Congress and a new President take office. It will
likely recommend legislative changes to revise the National Cancer
Act of 1971 and restructure parts of the program.
1971, it was thought that we had reached critical mass and that the
Cancer Act would take us over the top. That was wrong, said
Vincent T. DeVita, Jr., MD, co-chair of the National Cancer
Legislative Advisory Committee (NCLAC). I think we have
critical mass now. The investment in basic research has created
critical mass. [See the box at right for a further discussion
of the idea of critical mass.]
Dr. DeVita, director of the Yale Comprehensive Cancer Center and a
former director of the National Cancer Institute, described the
committees activities and process at a meeting of the National
Cancer Advisory Board (NCAB).
A common question directed at the committee is: If it aint
broke, why fix it? Dr. DeVita said, calling the National
Cancer Act one of the most successful experiments in biomedical
research by the federal government. Nonetheless, it is
quite obvious that while it aint broke, there are
many people who are not benefiting from the research effort of the
National Cancer Program.
NCLAC emerged from the National Dialogue on Cancer, a forum for
cancer advocacy groups. The National Dialogue is co-chaired by Sen.
Dianne Feinstein (D-Calif) and LaSalle D. Leffall, Jr., MD, professor
of surgery, Howard University College of Medicine. Sen.
Feinstein, after a few meetings, came to the conclusion that the time
had come to take another look at the entire cancer program, Dr.
She asked Dr. DeVita and John R. Seffrin, PhD, chief executive
officer of the American Cancer Society, to form a committee to gather
information from people with an interest in the National Cancer
Program, prepare a white paper, and make recommendations for
improving the program.
Were in a position a little different from other
committees, in that we can deal with what you would like to have in
the ideal and put something together that ignores the
conventional, Dr. DeVita said.
The NCLAC staff began by reviewing several recent reports assessing
the National Cancer Program and problems in cancer care. It also
conducted extensive interviews with researchers, oncologists,
advocacy groups, policy makers, and industry leaders involved in
supporting cancer research. The committee is now winding up eight
One of the issues in 1971 was: Money doesnt buy
ideas, Dr. DeVita said. Money does buy ideas by putting
bright scientists to work who have new ideas. The question now is,
Can we use the money for appropriate advice and more ideas?
One area the committee will address is whether organizational changes
are necessary that would allow all the federal cancer programs
to be put together in some sort of management scheme that would allow
us to accelerate the war on cancer, he said.
Dr. DeVita noted the decline in cancer incidence and mortality, which
began in 1990. He attributed this to the fact that from the beginning
of the National Cancer Program, 80% to 85% of its research budget has
gone to basic research, which has generated a wealth of molecular
information about the disease.
The cancer rates have declined very dramatically, he
said. And in fact, I think that when you see the mortality data
for the year 2000, you will be even more surprised how much death
rates are down.
The declining rates are due in large part to the 15% of research
funds that went into clinical application of the results of basic
research, Dr. DeVita said.
NCLACs work is funded mostly by the American Cancer Society,
with some money coming from industry sources. Despite the concern of
some advocates that its report would reflect the Societys
agenda, NCLAC is a totally independent organization, Dr. DeVita said.
The American Cancer Society cannot tell me what to do, and they
have been very good about that, he said. I have not been
told to do anything specific that would favor the Society.
NCLAC will not draft any proposed legislation and will leave that to
Sen. Feinstein and other members of Congress, he added.
Once the NCLAC members deliver their assessment of the National
Cancer Program and their recommendations, we will fold our
tents and go home, Dr. DeVita said.