We Fought Cancer…And Cancer Won.

There is a blueprint for writing about cancer, one that calls for an uplifting account of, say, a woman whose breast tumor was detected early by one of the mammograms she faithfully had and who remains alive and cancer-free decades later, or the story of a man whose cancer was eradicated by one of the new rock-star therapies that precisely target a molecule that spurs the growth of malignant cells. It invokes Lance Armstrong, who was diagnosed with testicular cancer in 1996 and, after surgery and chemotherapy beat it back, went on to seven straight victories in the Tour de France. It describes how scientists wrestled childhood leukemia into near submission, turning it from a disease that killed 75 percent of the children it struck in the 1970s to one that 73 percent survive today.

But we are going to tell you instead about Robert Mayberry. In 2002 a routine physical found a lesion on his lung, which turned out to be cancer. Surgeons removed the malignancy, which had not spread, and told Mayberry he was cured. "That's how it works with lung cancer," says oncologist Edward Kim of the University of Texas M. D. Anderson Cancer Center in Houston, who treated Mayberry. "We take it out and say, 'You're all set, enjoy the rest of your life,' because really, what else can we do until it comes back?" Two years later it did. The cancerous cells in Mayberry's lung had metastasized to his brain—either after the surgery, since such operations rarely excise every single microscopic cancer cell, or long before, since in some cancers rogue cells break away from the primary tumor as soon as it forms and make their insidious way to distant organs. It's impossible to know. Radiation therapy shrank but did not eliminate the brain tumors. "With that level of metastasis," says Kim, "it's not about cure. It's about just controlling the disease." When new tumors showed up in Mayberry's bones, Kim prescribed Tarceva, one of the new targeted therapies that block a molecule called epidermal growth factor receptor (EGFR) that acts like the antenna from hell: it grabs growth-promoting signals out of the goop surrounding a cancer cell and uses them to stimulate proliferation. Within six months—it was now the autumn of 2005—the tumors receded, and Mayberry, who had been unable to walk when the cancer infiltrated his brainstem and bones, was playing golf again. "I have no idea why Tarceva worked on him," says Kim. "We've given the same drug to patients in the same boat, and had no luck." But the luck ran out. The cancer came back, spreading to Mayberry's bones and liver. He lost his battle last summer.

We tell you about Mayberry because his case sheds light on why cancer is on track to kill 565,650 people in the United States this year—more than 1,500 a day, equivalent to three jumbo jets crashing and killing everyone aboard 365 days a year. First, it shows the disconnect between the bench and the bedside, between what science has discovered about cancer and how doctors treat it. Biologists have known for at least two decades that it is the rare cancer that can be completely cured through surgery. Nevertheless, countless proud surgeons keep assuring countless anxious patients that they "got it all." In Mayberry's case, says Kim, "my gut feeling is that [cells from the original lung tumor] were smoldering in other places the whole time, at levels so low not even a whole-body scan would have revealed them." Yet after surgery and, for some cancers, radiation or chemotherapy, patients are still sent back into the world with no regimen to keep those smoldering cells from igniting into a full-blown metastatic cancer or recurrence of the original cancer. Mayberry's story also shows the limits of "targeted" cancer drugs such as Tarceva, products of the golden age of cancer genetics and molecular biology. As scientists have learned in just the few years since the drugs' introduction, cancer cells are like brilliant military tacticians: when their original route to proliferation and invasion is blocked, they switch to an alternate, marching cruelly through the body without resistance.

We also tell you about Mayberry because of something Boston oncologist (and cancer survivor) Therese Mulvey told us. She has seen real progress in her 19 years in practice, but the upbeat focus on cancer survivors, cancer breakthroughs and miracle drugs bothers her. "The metaphor of fighting cancer implies the possibility of winning," she said after seeing the last of that day's patients one afternoon. "But some people are just not going to be cured. We've made tremendous strides against some cancers, but on others we're stuck, and even our successes buy some people only a little more time before they die of cancer anyway." She pauses, musing on how the uplifting stories and statistics—death rates from female breast cancer have fallen steadily since 1990; fecal occult blood testing and colonoscopy have helped avert some 80,000 deaths from colorectal cancer since 1990—can send the wrong message. "With cancer," says Mulvey, "sometimes death is not optional."

Yet it was supposed to be. In 1971 President Richard Nixon declared war on cancer (though he never used that phrase) in his State of the Union speech, and signed the National Cancer Act to make the "conquest of cancer a national crusade." It was a bold goal, and without it we would have made even less progress. But the scientists and physicians whom Nixon sent into battle have come up short. Rather than being cured, cancer is poised to surpass cardiovascular disease and become America's leading killer. With a new administration taking office in January, and with the new group Stand Up to Cancer raising $100 million (and counting) through its telethon on ABC, CBS and NBC on Sept. 5, there is no better time to rethink the nation's war on cancer.

In 2008, cancer will take the lives of about 230,000 more Americans—69 percent more—than it did in 1971. Of course, since the population is older and 50 percent larger, that raw number is misleading. A fairer way to examine progress is to look at age-adjusted rates. Those statistics are hardly more encouraging. In 1975, the first year for which the National Cancer Institute has solid age-adjusted data, 199 of every 100,000 Americans died of cancer. That rate, mercifully, topped out at 215 in 1991. In 2005 the mortality rate fell to 184 per 100,000, seemingly a real improvement over 1975. But history provides some perspective. Between 1950 and 1967, age-adjusted death rates from cancer in women also fell, from 120 to 109 per 100,000, found an analysis by the American Cancer Society just after Nixon's speech. In percentage terms, the nation made more progress in keeping women, at least, from dying of cancer in those 17 years, when cancer research was little more than a cottage industry propelled by hunches and trial-and-error treatment, as it did in the 30 years starting in 1975, an era of phenomenal advances in molecular biology and genetics. Four decades into the war on cancer, conquest is not on the horizon. As a somber statement on the NCI Web site says, "the biology of the more than 100 types of cancers has proven far more complex than imagined at that time." Oncologists resort to a gallows-humor explanation: "One tumor," says Otis Brawley of the ACS, "is smarter than 100 brilliant cancer scientists."