During the past year, 2 developments of particular relevance to the American Cancer Society’s (ACS) mission of “eliminating cancer as a major health problem” were prominent in national headlines. These included an escalation in the “war on cancer” and a vigorous dialogue on healthcare reform (the outcome of which remains uncertain at the time of this writing). Both have been viewed by much of the public and many healthcare professionals with a mix of optimistic enthusiasm and hope despite ongoing debate about the value of current accomplishments and the potential for future success. In that context, I have chosen to take this opportunity as the incoming ACS president to comment on our progress in cancer prevention, early detection, and treatment. But, we must not use evidence of our progress as an excuse to accept the status quo. Rather, we must recognize our responsibility to use these successes as the foundation for future progress as well as critically examine areas of more limited progress to determine how we can do better. Most views on cancer progress are framed by a mix of personal experiences and mass media. On a personal level, we see the cancer experiences of our family and friends, which can be biased in several ways. A personal cancer experience is blind to progress in cancer prevention. We can easily name individuals we know who are living with or have died of cancer, but we cannot do this for persons whose cancers were prevented. Also, although each of us probably knows several of the 11 million or more cancer survivors in the United States, we may not be aware that these individuals have had cancer. Thus, it is difficult to see a balanced picture through the lens of our own personal experiences with cancer. It is also difficult to get a balanced view of cancer progress through today’s mass media. There may be too much media coverage at both extremes of the optimism-pessimism spectrum. Surprising or controversial data receive the brightest lights. And what is reported is frequently interpreted outside the context of reality by those who receive the news. At one extreme are the “cure for cancer” stories of promising breakthroughs. Subsequent analysis shows that all too often such stories are based entirely on limited studies of cell cultures or laboratory animals. At the other extreme are claims that the cancer research endeavor has been a failure. Unsurprisingly, the truth is somewhere in between these extremes, and I believe that the metaphorical glass is more full than empty. The age-standardized US cancer death rate has declined by 16% since the death rates peaked in 1991 and by 9% since passage of the National Cancer Act in 1971.1 These mortality declines represent real progress and are occurring for the most common cancer sites in men and women— lung cancer in men, breast cancer in women, prostate cancer in men, and colorectal cancer in men and women—the single exception being lung cancer in women, where death rates have finally plateaued after several decades of increase (Fig. 1).2 These graphs show that cancer mortality trends during the 20 century are dominated by trends in lung cancer, particularly in men. Although tobacco remains the major preventable cause of cancer in the United States, tobaccocontrol advocacy has made important progress in reducing smoking rates through policy and legislative initiatives and Alan G. Thorson, MD, president of the American Cancer Society.

中文翻译：

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癌症护理的进展：理性呼吁做得更好

在过去的一年中，与美国癌症协会 (ACS) 的“消除作为主要健康问题的癌症”使命特别相关的两项发展在国家头条新闻中占据显着位置。其中包括“抗癌战争”的升级和关于医疗改革的激烈对话（在撰写本文时结果仍不确定）。尽管对当前成就的价值和未来成功的潜力一直存在争论，但大多数公众和许多医疗保健专业人士都以乐观的热情和希望的态度看待这两者。在这种情况下，我选择借此机会作为即将上任的 ACS 主席评论我们在癌症预防、早期检测和治疗方面的进展。但是，我们绝不能以取得进展的证据为借口接受现状。相当，我们必须认识到我们有责任利用这些成功作为未来进步的基础，并批判性地审查进展较为有限的领域，以确定我们如何做得更好。大多数关于癌症进展的观点都是由个人经历和大众媒体共同构成的。在个人层面上，我们看到家人和朋友的癌症经历，这可能会以多种方式存在偏见。个人癌症经历对癌症预防的进展视而不见。我们可以很容易地说出我们认识的患有癌症或死于癌症的人的名字，但我们不能为癌症得到预防的人命名。此外，虽然我们每个人可能都认识美国 1100 万或更多癌症幸存者中的几个，但我们可能不知道这些人患有癌症。因此，很难通过我们自己与癌症的个人经历来看待一个平衡的画面。通过今天的大众媒体，也很难对癌症的进展有一个平衡的看法。在乐观-悲观光谱的两个极端，可能有太多的媒体报道。令人惊讶或有争议的数据会收到最亮的光。所报道的内容经常被接收新闻的人在现实背景之外解释。一个极端是有希望的突破的“治愈癌症”的故事。随后的分析表明，此类故事往往完全基于对细胞培养或实验室动物的有限研究。另一个极端是声称癌症研究努力失败了。不出所料，真相介于这些极端之间，我相信比喻的玻璃杯比空杯更满。自 1991 年死亡率达到顶峰以来，美国年龄标准化癌症死亡率下降了 16%，自 1971 年通过《国家癌症法案》以来下降了 9%。这些死亡率下降代表了真正的进步，并且正在发生在男性最常见的癌症部位和女性——男性肺癌、女性乳腺癌、男性前列腺癌和男性和女性结直肠癌——唯一的例外是女性肺癌，其死亡率在几十年的增长后最终趋于稳定（图 1） ).2 这些图表显示，20 世纪的癌症死亡率趋势主要是肺癌的趋势，尤其是男性。尽管烟草仍然是美国癌症的主要可预防原因，