What Remains to Be Done
Authors: Nancy G. Brinker
Journal: Cancer Research (2007)

I feel a little like Mary Lasker, who was asked late in her life if she had to start over again whether she would consider a career as a scientist. She replied, “Oh no! I couldn't cut up a frog! And I certainly couldn't perform surgery! Nobody would have me in their laboratory for five minutes!” As I have said before, I am not a researcher (although some of you, perhaps against your better judgment, have let me in your laboratories). However, I am proud to bring the survivor perspective as a member of the AACR's new Council of Scientific Advisors, and I have striven to be what was said of Mary Lasker, “a matchmaker between science and society.”Today, we are celebrating the amazing results of this partnership between society and science: more life-saving treatments, millions more survivors, more hope for cures. You scientists are reviewing the great possibilities and challenges as you work to translate today's science into a new era of prevention and cures. Now, I want to step back, and I would like to speak candidly.This is an unprecedented moment in the war on cancer. We've seen the first-ever decline in cancer deaths. Private sector investment in research is great and growing. The coming years have the potential to be the most exciting in the history of cancer research.I have been an advocate now for a quarter century (and have the wrinkles and gray hair to prove it). Even as I rejoice in all the progress and possibilities, I am concerned, deeply concerned, that we may fail to seize this moment. Let me say it simply, I have never been as worried about our nation's commitment to the war on cancer as I am today. I believe we are in grave danger of losing our culture.What do I mean? More than three decades ago, when our nation, led by a Democratic Congress and a Republican President, came together to declare a “war on cancer,” there was a culture of energy, excitement, urgency, action, vitality, and unity of purpose, including support for pioneering research. But today, 36 years into the war on cancer, I fear a Culture of Complacency. I fear a Culture of Complacency when our nation, government, industry, and academia spend perhaps $11 billion a year researching a disease that costs our country more than $200 billion a year. When we have to fight simply to prevent cuts to federal support of cancer research just when we should be increasing funds to realize the amazing possibilities of this new era of research. And when life-saving screening programs, like the National Breast and Cervical Cancer Early Detection Program, reach only a tiny fraction of eligible women.But this is about more than money. I fear a Culture of Complacency, “cancer fatigue,” when there is no longer outrage over a disease that still kills more Americans every year than died in all the wars in the 20th century! When society and celebrities bounce from one disease du jour to the next. When some even suggest we should stop calling it a “war” on cancer. Americans, racial and ethnic minorities, the poor, and those with little or no insurance, are less likely to receive quality cancer care and are more likely to die. But where is our sense of outrage? The baby boomers are about to become an unprecedented cancer boom, threatening to destabilize our entire health care system. But where is our sense of urgency? I fear a Culture of Complacency and frankly, low expectations. When we celebrate as “breakthroughs” treatments that cost patients $50,000 per treatment and extend life, at most, a few months. And when those of us in the cancer community, advocates included, engage in self-defeating fights for resources and attention. I can't tell you how often I'm approached by people who can't understand why we bicker over billion-dollar research budgets. Average Americans look at us like wealthy people arguing over which five-star restaurant to go to. And I fear a global culture of complacency when the IARC's Dr. Peter Boyle has to shout from the rooftops that the number of new cancer cases diagnosed every year, already more than AIDS, tuberculosis, and malaria combined, will double by the year 2030, to 27 million cases. This will account for 17 million deaths every year!I also fear a Culture of Complacency within the scientific enterprise. Systemic incentives for profit, publication, and prestige often lead to competition instead of the communication and collaboration necessary for major advances. I see it when I meet women from Eastern Europe to the Middle East who ignore the lumps in their breasts for fear of losing their husbands, or fear that touching it will make it spread, or who fear that it's contagious. This is the same culture of myth and misinformation women in our country, like my sister Susan, faced 30 years ago. And I fear a Culture of Complacency when a Palestinian physician in the West Bank tells me that, like the understaffed, overworked oncologists, nurses, and midwives throughout the developing world (home to 70% of new cancers), he fears being swamped by the coming “cancer tsunami.”When I was a young woman in college, when there were few women leaders to look up to, I watched and admired Mary Lasker for the way she helped spark the war on cancer. When I started The Susan G. Komen Foundation a few years after my sister died, I met the woman I considered to be my role model. And so, I look out at this culture today and ask myself: “What would Mary do?” “What would that founding generation of the war on cancer do today?” Well, I certainly don't have all the answers. None of us does. But I think Mary would do what she did then, and what we have tried to do with breast cancer at Susan G. Komen for the Cure. We must change the culture, the very way we think about and wage this war on cancer.I believe this is a defining moment. Elizabeth Edwards and Tony Snow have recently put cancer back on the front page and sparked a long-overdue national discussion of this disease, where we stand and what we need to do. Our collective challenge is to ensure that this national conversation leads to national change. It is imperative that we seize this moment to give rise to a new culture: a Culture of Discovery, a Culture of Excitement, a Culture of Optimism, a Culture of Timelines. In this Culture of Discovery, the cancer community, advocates included, declares a cease-fire in the “disease wars.” Once and for all, we stop the infighting. Why can't we forge consensus on a few priority research areas and then speak with one, loud voice to Washington? In this Culture of Discovery, there would be a new boldness, the courage to explore truly revolutionary ideas as well as the courage to stop funding research or clinical trials that are duplicative, even if it means having to reinvent our careers or laboratories. In this Culture of Discovery, there would be a new spirit of communication, within and across disciplines, so that new data and knowledge are shared and disseminated as quickly as possible. Why not, for instance, a central, comprehensive database of cancer research results, published and unpublished, including “negative findings” and informed opinions? Just imagine the time, money, and energy and lives that could be saved.There should be a new spirit of collaboration. Why can't we have more settings like Israel's Weizmann Institute—which Komen has funded and which I visited last month—where we bring together the best minds of every discipline and give them the freedom, and funding, to explore the most vexing questions in cancer research? Can't we reverse the underlying economic incentives—how researchers are paid, promoted, rewarded, and recognized—so that genuine collaboration and high-risk, high-reward research is encouraged, not discouraged? And why can't we find a new approach to patents and to collecting, preserving, and tracking human tissue and tumor specimens? Surely we can find ways to promote collaborative research without undermining our nation's position as the world's scientific and economic leader. And in this culture of discovery, there would be a renewed commitment not only to discovery, but to delivering new treatments and cures to those most in need—to bring real results to real people—not only in our country, but to translate what we know around the world.This isn't just a matter of national leadership; it's a matter of global leadership. We are the wealthiest, most medically advanced nation on earth. The world is looking to us. And if we do not lead and act to avert that “cancer tsunami,” the lives of millions will be lost. As I said, I don't have all the answers. But I know that this not a problem of politics. The historic doubling of the NIH budget occurred under a Republican Congress and two presidents, one Democrat and one Republican. Nor is this simply a problem of money. Even with recent cuts, federal funding for cancer research, in historic terms, remains at record highs. No, this isn't a matter of politics or a matter of money. This is a matter of national will. And I believe that those of us here, the leaders in the field, must be the ones to summon that will.If we can rally the American people to demand that the war on cancer be a priority again, no politician will dare stand in the way. If we have the right culture, the will, and the urgency, all things become possible!I pledge to you that I, and those of us at Susan G. Komen for the Cure, will continue to do our part:The promise I made to my sister as she lay dying, the promise you made in your lives to your families and institutions, was not a promise of complacency. Rather it was a promise of action. It's a promise I think about every minute, because, right now, cancer is taking my father. And so I borrow again the words of Marie Curie, “I never see what has been done. I only see what remains to be done.”My friends, we know what remains to be done. The only question is, Do we as a cancer community, as a nation, have the will to do it?