Vincent T. DeVita - The Death of Cancer: After Fifty Years on the Front Lines of Medicine, a Pioneering Oncologist Reveals Why the War on Cancer Is Winnable--and How We Can Get There

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To my daughter, Elizabeth, my son, Ted, and their mother, Mary Kay; my inspiration.

And to my patients everywhere.

Heroes all of them.

When I was a child in the 1940s, long before I had any notion of becoming an oncologist, Aunt Violet, my godmother and a frequent visitor in my household, stopped coming over. My parents ceased talking about her, too. It was as if she had disappeared. Several months into this state of affairs, my father drove me from our home in Yonkers to her apartment in New York City. He told me that she was sick and that she wanted to see me.

We went in, and I sat on the living room floor, playing with the toy car Aunt Violet had given me. The Ink Spots crooned If I Didnt Care from the record player. Aunt Violet was a bubbly woman, by far my favorite relative. We had a special bond. It was just like her to put on the music I loved when she knew I was coming.

I looked up when I heard the bedroom door open. The Aunt Violet I knew was vivacious, with dark brown eyes, curly brown hair, and a voluptuous figure; the woman who stood watching me was quiet, gaunt, and sad. Her skin looked yellow next to her white chenille bathrobe. I was only six, but I knew something was terribly wrong.

I knew also that I should talk to her, but I didnt know what to say. I ducked my head and began running my car around the legs of the record player, too scared and confused to look up. I was acutely aware of her standing there, silently, watching me. Finally, my father told me it was time to go home. I picked up my car, and we left. Several weeks later, my parents told me that Aunt Violet had died. She was just thirty-six.

Years later, I learned that shed had cervical cancer. Her case had apparently been so advanced by the time she was diagnosed that there was little her doctors could do. There wasnt much that could be done for most people with cancer in those days, even if it was caught early. The main treatments were surgeries that were often disfiguring or toxic doses of radiation. Those treatments helped only the lucky few whose cancers were discovered before they had spread. There were no drugs to fight cancer then. And barely more than a third of people diagnosed with it survived.

It was such a dreadful diagnosis, in fact, that many people, including my parents, couldnt bring themselves to utter the word. If they did, it was in a whispercanceras if there were something shameful about it. Or maybe it was superstition, the fear that merely saying the word out loud was tempting fate, like waving a red cape in front of a bull. Individuals like my aunt were the incarnation of peoples worst fear: apparently healthy one minute, facing certain death the next.

Two decades after my aunts death, as a newly minted doctor, I found my career taking an unexpected turn. A couple years after graduating from George Washington Universitys medical school, I walked onto the cancer wards at the National Cancer Institute (NCI), a reluctant trainee. I wanted to be a cardiologist, but Vietnam was in full swing, and doctors werent exempt from the draft. The National Institutes of Health (NIH), which included a number of disease-specific institutes, was one of the few legal outs. It was part of the Public Health Service, which was considered one of the uniformed services. If you served there as a clinical associatethat is, a traineeyou got credit for serving in the armed forces. Id blown my interview for a spot as a clinical associate at the National Heart Institute. Yet Id been offered one at the National Cancer Institute. It was a depressing assignment. But it was fighting cancer or stitching people back together on the battlefield. I chose cancer.

At the NCI, I saw a lot of people who looked just like my aunt Violet had at the end of her life. Gaunt. Sad. Yellow. In the many years since her death, neither the treatments nor the survival rate had changed much. People still whispered the word cancer. One of my first patients told me that when he and his wife took their evening walk, their neighbors quietly slipped away, as if what he had were catching. At cocktail parties, even his friends served him his drinks in paper cups, so fearful were they that his disease, or his bad luck, was contagious and couldnt be washed off the glassware.

The study of cancer was a stagnant field, a no-mans-land populated by only a handful of doctors and researchers regarded by most of their colleagues as nuts, losers, or both. Thats what I thought, too. It was what most people in the medical field believed. When I was a medical student doing my hospital training at George Washington University Hospital, thered been just one doctor, a beak-nosed endocrinologist named Louis K. Alpert, who dared to try to do more for these patients. He was dosing them with nitrogen mustard, the first anticancer drug to be discovered, in the hope that he could kill their cancer without killing them. Nobody thought he would succeed. Most people mocked him behind his back. We called him and his medicine Louis the Hawk and his poisons.

There were not many like himphysicians trying to extend the lives of cancer patients. More commonly, the patients were sent to nursing homes to die or told to go home and get their affairs in order. That patients might want a shot at something more was not part of most doctors thinking. The general feeling was that efforts to cure cancer patients were bound to fail. As late as the 1960s, the respected chief of medicine at Columbia University refused to let his medical trainees make rounds on the cancer wards, lest their careers be tainted by the futility they would encounter there. This chief of medicine told the doctor in charge of this ward, the late Alfred Gellhorn, who did want to try to do more for these patients, that he was part of the lunatic fringe.

And so it would have continued, if not for work that would soon begin at the National Cancer Institute, initiated by a handful of mavericks on the same wards where I landed as a trainee in 1963. Their research, in which I took part, led to the first use of a combination of drugsknown as combination chemotherapyto treat and, increasingly, to cure childhood leukemia. Learning from them, I came up with a combination chemotherapy regimen for Hodgkins disease, which cured 80 percent of people with advanced disease.

It was a first, and it did not escape the notice of a brilliant, wealthy socialite and influential health advocate, Mary Lasker, who had lost her own husband to cancer. Before long, with her unique combination of political acumen, medical savvy, and a dedicated pool of lobbyists, Mary managed to convince the president, Congress, and the nation that we were on the brink of a breakthrough and that it was time to invest large sums of money to conquer cancer.

On December 23, 1971, in front of a throng of journalists, a jubilant President Richard M. Nixon signed the National Cancer Act, which launched the war on canceran unprecedented federal research effort. The legislation set aside $100 million for the research, to be overseen by the director of the National Cancer Institute, who would be appointed by the president.