Part 3

Her-2, The Making of Herceptin: a Revolutionary Treatment for Breast Cancer
by Robert Bazell

(Page 3 of 5)

There were some oddly funny moments, too. She describes how some friends would glance down at her chest as they were trying to figure out which breast was real and which had been reconstructed. "They just couldn't help themselves," she chuckles. After the initial burst of concern, people began to lay off the subject. And for a while, she was able to put cancer out of her mind.

Until this century, cancer was considered mostly a woman's disease, and it often carried the stigma of shame. Without modern diagnostic tools, physicians could more easily recognize cancers of the breast, cervix, and ovaries. Untreated breast tumors bulge and can break through the skin; untreated cervical and ovarian cancers lead to prodigious bleeding. Thus physicians believed erroneously that cancer strikes women more often than men. Until the last twenty years or so, cancer, and most especially cancer of the female organs, was not a topic of polite conversation. In the atmosphere of denial, women were all too often left to suffer with their illness alone, unable to find support as the disease destroyed them physically and emotionally.

When Anne McNamara's breast cancer struck, the shame associated with the disease was diminishing. Since the turn of the century, improved diagnostic techniques were proving cancer to be an equal-opportunity disease. But treatment for breast cancer has improved little over the last several decades, remaining a variation on the themes of surgery, radiation, chemotherapy, and hormone treatment. Separately and in combination, these options can be effective treatments and can sometimes bring about a remission that lasts long enough to be reasonably called a cure.

Surgery does not always excise the cancer entirely. Chemotherapy and radiation are often just random attacks on the problem, destroying much but not necessarily all of the cancer and usually harming healthy tissue in the process. Hormone treatment works for some breast cancer. The new approaches, such as adjuvant chemotherapy, can bring profound benefits, but they amount to little more than adjustments to the standard procedure. The problem is that breast cancer is unpredictable. Sometimes it is wholly contained in a tumor. But all too often it spreads from the tiniest tumor long before it can be detected or removed. Why do some cancers produce micrometastases, tiny bits of cancer that migrate from the original mass? No one knows.

The death rate for breast cancer stands as a dismal monument to ignorance. It has changed little in half a century. Every year the disease strikes more than 180,000 women in the United States and kills about 44,000. In 1950, the first year the government kept such records, 264 out of every 1 million white American women died of breast cancer. Twenty-five years later, that death rate was exactly the same. By 1985, it had risen to 275. In the 1990s, it began falling slightly; by 1995 the rate had dropped to 248, 6 percent less than it had been forty-four years before. The picture for African-American women is even more discouraging. Initially, the government kept no records of breast cancer in black women. In 1973, the first year that such records were compiled, the death rate from breast cancer for black women was 263 for every 10,000. By 1995, it had soared to 319.

Many scientists believed those statistics could improve only with profound new insights into the nature of cancer itself. For almost a century, scientists have been raising research funds by promising that such breakthroughs were imminent. In 1898, Dr. Roswell Park, a surgeon in Buffalo, persuaded the New York State legislature to create the Institute for the Study of Malignant Disease by declaring that "the cure is just around the corner." The state built the institute, which was named after Roswell Park following his death. But the reality was that no one understood the fundamental biology of cancer - a word that covers approximately 110 distinct ailments.

The National Cancer Act, signed by Richard Nixon on December 23, 1971, amounted to a leap of faith based on exaggerated claims worthy of Roswell Park and on the perennial belief that the government can solve any problem by simply throwing money at it. The War on Cancer, as it was called, brought unheard - of sums of money to the field. Between 1971 and 1979, the budget of the National Cancer Institute climbed from $230 million to $940 million. Grant money did flow to cancer research, so much so that scientists seeking funding for other areas of basic research, like the fundamentals of the chemical reactions in cells, often justified their applications by fabricating some hypothetical application of their research to cancer. But in 1971, money was hardly the only obstacle standing in the way of a cure. Cancer research remained a scientific backwater where no one seemed to be making any headway. Most distinguished scientists regarded cancer research as a bastion of mediocrity where less talented scientists followed the money to perform meaningless experiments. Robert Weinberg, a pioneer in cancer research, recalls a senior colleague admonishing him "never, ever, under any circumstance, to confuse cancer research with science."

Cancer, the uncontrollable multiplication of cells, has existed from the moment single-celled organisms joined together to form multicelled plants and animals. Cancers have been found on dinosaur bones and on Egyptian mummies. Growing and dividing is the most basic function of individual cells. It is the impulse by which life has survived and evolved for billions of years. Every cell in our bodies carries this evolutionary force. But when cells band together to form a higher organism, they must answer to a more advanced impulse. Strict controls govern the proliferation of the body's individual cells. If the body's control mechanisms fail and individual cells reproduce beyond the limits of the system, cancer is the result.

What causes the deadly failure of control? Soon after the turn of the century researchers knew that radiation, chemicals, and viruses could trigger cancer. But this knowledge still failed to provide a satisfactory description of the actual change that is cancer itself.

© 1998 Robert Bazell.

About the Author

Robert Bazell is the chief science correspondent for NBC News. His reports, which appear on the NBC Nightly News, Today, and Dateline NBC, have won every major award in broadcasting. He has written for many publications, including The New Republic, The New York Times, and The New York Times Magazine. He lives in New York with his wife, Margot, and daughter, Stephanie.