In 1971, Richard Nixon, then President of the United States, announced a “war on cancer“. Expectations were high, especially considering that just two years earlier, the Apollo program had sent astronauts to the moon. So, given scientific advances, some doctors were even talking about a cure for cancer within a few years.

But they didn’t fall within their predictions. Today an adult either has been diagnosed with cancer, or knows someone who has, or both. Half of men and a third of women in rich countries are expected to get the disease at some point in their lives. In the US, cancer is the second most common cause of death after heart disease, killing about 600,000 people a year. Worldwide it accounts for about one in six deaths. These data show that the battle with the disease is lost.

The reality is different and progress in dealing with cancer is significant. According to a report in the Economist, there are good reasons to believe that this progress will continue.

Cancer is associated with age. It is becoming clear that in rich countries the early 1990s was a turning point. Since then, the age-adjusted mortality rate has been slowly but steadily declining each year. In the Americas, the rate is now about a third lower than in the 1990s. A similar trend is observed in other developed countries.

What some scientists expected to be a lightning “war” has turned into a slow but successful war of attrition. Some victories have been impressive. Childhood leukaemia once amounted to almost a death sentence; today it has a five-year survival rate of over 90%. However, because cancer is not one disease but a whole class of diseases, progress is due not so much to major breakthroughs but to thousands of smaller advances in screening, surgery and drugs.

Future successes will come from three main sources, as noted in the Economist article:

– Implementation of lessons from the developed world worldwide. The most overlooked success in the fight against cancer is prevention. This is perhaps because cancers that do not appear are less “visible” than those that are cured. For example, smoking rates have fallen dramatically in rich countries, which has probably prevented over 3 million cancer deaths in the US since 1975. Because smoking still causes one in five cancer deaths worldwide, anti-smoking campaigns in poor and middle-income countries, where smoking is still prevalent, can save countless lives.

– Cheaper drugs and increased resources to fund them. Cervical cancer is one of the most common in women and almost all cases are a late consequence of HPV infection. In 2008, Britain began offering a new HPV vaccine to teenage girls. Fifteen years later, cervical cancer rates in women aged 20-29 have fallen by 90% and health authorities are talking about almost complete elimination of the disease by 2040. The original vaccine was relatively expensive, but a cheaper version from India is now supporting an extensive vaccination campaign in that country as well.

– Clinical use of the new science. This proceeds in two stages: identifying those at greatest risk of developing cancer and then finding ways to stop the disease before it progresses. Both of these stages look promising, according to the Economist.

Scientists already know of genetic variants that increase the likelihood of cancer, such as the defective gene BRCA-1 that increases the risk of breast or prostate cancer. However, fewer than half of cancer patients have a known risk factor. Also, only a few precancerous cells develop into malignant cells. For example, bowel cancers often start as polyps, but only 5-10% of these become malignant.

The goal is to clarify this picture so that patients can be identified very early, when treatment is most effective. This relies on huge tissue banks and the ability to track genes in living cells, which was unimaginable a decade ago. With new biomarkers in blood or breath, and a deeper understanding of how combinations of genes and environmental factors lead to cancer, doctors can target those who will really benefit from treatment. This is important as it prevents unnecessary surgery, chemotherapy and radiotherapy.

Cheap drugs that are effective in the fight against cancer

Once those who need treatment have been identified, doctors can use an ever-growing arsenal of therapies. Some cheap drugs appear to act as preventive anticancer agents. aspirin, for example, halves the risk of bowel cancer in people with Lynch syndrome. Metformin, a cheap diabetes drug, reduces the risk of recurrence in women who have a certain type of breast cancer. Even GLP-1 receptor agonists such as Ozempic show positive results.

Alongside the basic treatments – surgery, chemotherapy and radiotherapy – a new technique is emerging that harnesses the immune system. The idea is to boost the body’s natural ability to attack cancer cells. Some vaccines – possibly genetically tailored – target cancers that have already appeared. Others, more preventive, target pre-cancer cells, as is the case with common flu vaccines. Such vaccines for breast and colon cancer are already in clinical trials.