Colleen Casey fingers a patchwork quilt stitched by her daughter Susan before the young mother of three died last spring.
Casey, 65, a retired La Mirada nurse, is not naive to the cruelty of illness. Her mother died of breast cancer. In 1966, at age 40, Casey underwent a bilateral mastectomy for breast cancer. She had raised her daughter, Susan Bassett Feldman, to be aware of her increased risk of breast cancer; her family history put Susan's chances of developing the disease at 1 in 2, far above average.
Susan regularly examined her breasts for lumps and had frequent mammograms. At one point, she asked her doctor if she could undergo a prophylactic mastectomy--a procedure where the breast tissue is removed and replaced with implants to lessen cancer risk. She was discouraged from taking that radical step.
When she found a lump in her breast at age 40, Susan sought the best medicine had to offer--including undergoing harsh, experimental treatments when the cancer spread to her brain and spinal fluid. But the disease won out.
Susan spent her last months making each of her three children and her mother patchwork quilts and pillows. Colleen Casey stayed by her side, administering massive doses of morphine to ease Susan's pain. Susan died March 3 at age 42.
Casey is dry-eyed as she says: "I thought I was helping my daughter do all the things that were necessary. And she followed all the rules. What is frustrating is that the results from treatment now are not a heck of a lot better than they were when I had cancer. I am watching her two daughters, ages 22 and 14. I'm hoping the outlook will be better for them, but I'm not sure it will. Twenty-five years after my cancer, why should I still be worried about my granddaughters?"
Casey folds the quilt and puts it in a closet.
"It is still a long, hard road before we conquer this dreadful disease."
Few cancer experts would argue with that.
While optimism for the future is technically grounded in auspicious work in genetics, biotechnology, prevention, early detection and new drugs, almost half of all people who get cancer die from the disease within five years--about 514,000 deaths a year in the United States.
Survival rates have only increased 4.1% since the mid-1970s, making the National Cancer Institute's 1985 goal of reducing cancer mortality by 50% by the year 2000 painfully remote.
Moreover, the incidence of cancer is increasing for reasons that are poorly understood. Breast cancer has increased about 3% a year since 1980; melanoma, 4% a year; prostate cancer, 2.8% a year. Among children under 14, brain tumors and leukemia incidence have soared over the last two decades.
At current rates, one of every three Americans can expect to develop cancer at some time in their lives. As life expectancy increases, cancers that are more common in old age--colon, prostate and breast--are also expected to continue to increase.
Despite its successes, the war on cancer has not resolved many troubling aspects of the disease.
Researchers promote cancer prevention and early detection as major tactics to greatly lower cancer death rates. But the realities of achieving either on a grand scale are far from certain.
Experimental new treatments such as gene therapy and the use of biological agents show great promise. But they are only now being tested and there is no guarantee that these are the answer, either.
In the meantime, physicians admit that they are left to strive for greater success by eking out improvements in the traditional forms of cancer treatment: surgery, radiation and chemotherapy. Each of these treatment approaches, so far, has serious limitations.
For example, people die of cancer largely because none of the current treatment approaches are very effective at stopping metastasis--malignant cells that have spread beyond the primary tumor to other parts of the body, said Dr. Lance Liotta, chief of the NCI's laboratory of pathology.
"Metastasis is the real reason cancer is lethal," Liotta said. "If we can control metastasis, we would really be able to prevent death."
Even when there is no sign of disease in the lymph nodes--where the tissue cancer is likely to spread first--25% to 30% of patients probably still have "micro metastasis," which cannot be seen in the cells examined under a microscope.
"In time, those cells will grow and become life-threatening. We need better markers to show when that might happen," Liotta said.
When cancer is detected early, treatment is often overwhelmingly successful. But the opportunities for early detection are only beginning to emerge. Because of a lack of symptoms, ovarian, pancreatic and lung cancer typically are not discovered until later stages.