The conquest of cancer

by H. W. S. Wright

The Executive Committee of the British Empire Cancer Campaign have recently published a statement based on the last census. They say that, during the year 1921, in Great Britain, of persons over 30 years of age, one out of every seven died of cancer.

These figures make it plain that the question is not merely one of interest to doctors and scientists; it is of concern to every one of us, and to one person in every ten it has direct and very personal interest.

Surgery and medicine have very little further to advance along technical lines, so far as the type of case we see at present is concerned. It is nearly impossible to make operations more extensive and thorough than they are at present; and it is unlikely that the operative mortality in the average good risk will fall much lower than its present very small figure. Other methods of curing cancer do not at the moment show promise of producing anything so good as the present surgical results. We have therefore to resort to an educational campaign for its victims before we can get much further on.

This brings me to the first point to be brought home before any more is said—that early cancer and late cancer are, so far as results and cures are concerned, two entirely different diseases. A well-known English authority, speaking of cancer of the tongue, says: “An early superficial cancer on the free part of the tongue should be, and is, curable in practically all cases. The general conviction of the incurability of cancer is founded on the results of operation on the average fairly advanced case and, until this conviction is shaken, I fear the public will remain relatively indifferent and pessimistic as to the advantages of early treatment. Every surgeon of any experience is aware that, as regards its accessibility to treatment, early cancer is a totally different disease from even moderately advanced cancer, but I am very doubtful as to whether we shall be able to enforce the fact by direct statement so long as the treatment of advanced cases furnishes the public with so many terrible object lessons in the apparent intractability of the disease.”

The problem we have before us, then, is that of changing the whole attitude, not only of the physician, but of the patient, to cancer. Here is an example of the present point of view:—I have frequently heard it said that such and such a patient has a lump, or some disquieting symptom or other, but she won’t go to the doctor as she is afraid he will say it is cancer. What we have to do is to strip this disease of its fear-complex and bring all the facts about it into the open. We have to change the attitude of the patient, and often, unfortunately, of his doctor, from one of “wait and see” to one of “look and see.” Then, and only then, shall we be on the way to curing cancer.

The results of the present-day and popular point of view are appalling. Somewhere about half the cases of cancer are far too advanced for us to think about curing them at the time the patients appear. Of the remaining half, approximately two-thirds have about a thirty per cent. chance of cure, and the remainder about a sixty per cent. chance. These figures are rough estimates based on impressions formed in hospital out-patient work, but they will not be found far wrong. The heart-breaking part of it is that it is all the result of fear, carelessness and crooked thinking, which could be avoided in a large percentage of the cases.

Yet there are signs that we are entering on a new phase, and that a realisation of the importance of early diagnosis is slowly permeating through the medical profession. In America we see an increasing insistence on the use of detailed and specialised laboratory methods for exact diagnosis; and in Great Britain there is in existence, at St. Andrew’s University, a complete medical unit, under the supervision of Sir James Mackenzie, for the investigation of the early symptoms of disease. The establishment of this institute is, I think, one of the most important advances that medicine has made in the last twenty-five years, for it is a milestone on the road to progress, a concrete and tangible expression of a changed point of view.

Let us for the moment leave generalities and give some few minutes to more detailed consideration of the disease; first in outline, and then in respect of some particular cases.

Cancer is a degeneration. It most often occurs at that period of life when our biological work is done, and, as far as Nature is concerned, we are of no use. From her point of view we are on this planet to reproduce our kind and, when we are past doing that, our tissues begin to lose their firm hold on their appointed form, and stray from their former habit of exactly reproducing their kind when attempting to recover from any kind of injury. Cancer is commonest in those organs which have soonest finished their work—the reproductive organs of women; and, after these, it appears most often in that organ so much more abused than any other—the stomach.