the development and spread of cancer, and there was no evidence that there was an overall reduction in the number of deaths from cancer.

Progress Report 2, an assessment performed independently of NCI, stated that the wrong strategy was pursued and suggested that a prevention strategy would yield the desired results. These are only partial answers to the questions. Knowing and removing the cause of disease can often achieve substantial results without providing an understanding of the underlying mechanisms, but even then, change does not always occur quickly. Lung cancer is highly preventable and the relationship between tobacco use and cancer has been known since 1950, but the rates of mortality from lung cancer have only recently begun to decline and the rate among women is still rising. Furthermore, cancer is not a single disease affecting one organ, but rather, it is a complex of diseases related to a variety of factors. Prevention efforts are long term and require a broad spectrum of disciplines, and individuals trained to work in these disciplines are in short supply.

Progress Report 3 is partially the result of a failure to provide an adequate answer to the fundamental question.

The 1998 report card (Wingo et al., 1998), based on data from the NCI SEER program and NCHS, provides more evidence that progress is actually occurring, but notes that not all populations have benefited equally from advances against cancer. It also suggested that progress will be slow. The Healthy People 2000 report (U.S. Public Health Service, 1991) indicates that progress has exceeded expectations in some areas but has been disappointing in others. Good news about prevention (tamoxifen) and treatment (herceptin) might emphasize the need to continue vigorous efforts on both fronts.

Following publication of the reports of the panels on Measuring the Progress Against Cancer (Extramural Committee to Assess Measures of Progress Against Cancer, 1990), a special National Cancer Advisory Board Committee concluded that much of the cause of the failure to achieve the desired results was beyond the domain of NCI. It clearly defined three research categories: basic research (the foundation and engine), translational research (the bridge between basic research and application), and applications research (in which the participants were neither researchers nor the funding agencies). The NCI-designated cancer centers were to be the primary bodies conducting the research, along with the community clinical oncology programs and the clinical trials cooperative groups. The centers and related programs were to participate in public information programs, community outreach activities, and training programs for community-based physicians. The committee offers a more thorough discussion of the cancer centers in Chapter 3.

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