progress report included specific advances in several areas, including the following:

• control of tobacco use;
• development of information dissemination programs about screening for the detection of breast and cervical cancers;
• development of strategies to reach special populations at high risk; increased public interest and activism in reducing cancer risk and participating in screening and early-detection programs;
• improving the quality for life of cancer survivors;
• recognition of the importance of population-based health care providers in the dissemination of state-of-the-art cancer prevention and treatment; and
• educational efforts to inform individuals about reducing their risk of cancer through dietary modification.

This was an impressive record of accomplishments, and it was accompanied by statistics that showed that there had been progress against some cancers, little change in progress against other cancers, and significantly increasing public health problems posed by still other cancers.

A different assessment of the War on Cancer was best expressed by John Bailar, the first director of cancer prevention research at NCI, although it was also held by others. His view was that the War on Cancer had been a failure. This was not a new conclusion for Bailar and colleagues (Bailar and Gornik, 1997; Bailar and Smith, 1986), and the overall mortality statistics supplied by the Institute were consistent with his conclusion. Despite the War on Cancer, the numbers of deaths from cancer had increased, and different interpretations had been made to explain the increase. The largest contribution to the increase was due to lung cancer. Those rates were beginning to fall for men but were still rising for women. When one excluded lung cancer from the statistics, the conclusions allowed one to be optimistic, but the reason for excluding lung cancer was recognition of the fact that deaths from lung cancer would decrease only over a period of many years, even if the rate of smoking were sharply reduced. The greatest impact would come from an emphasis on smoking prevention rather than smoking cessation. Bailar and colleagues concluded that the Institute needed to change its strategy if it wanted to win the War. It needed to emphasize prevention.