WINNING" is the chant reverberating "W and amplifying among those actively involved in the war against cancer. This optimism is based on advances in therapy, particularly multi-modal therapy, and to a large extent to greater efforts at early detection. In the 1930's, our salvage rate was less than 20%; only about one of five cancer patients was alive five years after treatment. In the 1940s, this advanced to one of four 25%. Then, in the 1950s and 1960s, we were very proud of our ability to cure one of every three cancer patients 33%. We further extended the cure rate to 41% for those patients diagnosed between 1967 and 1973. Recent data from the National Cancer Institute on patients diagnosed from 1973 to 1976 indicate a 48% cure rate, and for white patients diagnosed between 1976 and 1982 the cure rate is 50%; one of every two patients cured! When we saved 1 person in 5, just being alive after cancer treatment was success. Now that we are curing 1 of every 2 cancer patients we are readapting people to their pretreatment environment, while planning beyond readaptation to the total elimination of the personal, social and economic burdens of cancer by preventing its development.
However, we are not working in a totally supportive environment; even in this time of enlightenment there still are notable doubters. For example, most of us are familiar with a recent paper by Bailar and Smith exorting a shift in research emphasis from treatment to prevention, who state, "We are losing the war against cancer. The main conclusion we draw is that some 35 years of intense effort focused largely on improving treatment must be judged a qualified failure."' To further illustrate our potential problems with early detection and prevention, I quote the paper of Skrabanek of