Pink ribbons and yellow bracelets

The strange paradox of cancer’s persistence in the face of public optimism about progress toward a cure

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The statistics, if not without areas that show glimmers of hope, are unsettling. As reported in the New York Times, data from the National Center for Health Statistics show that death rates since 1950 plummeted for heart disease, stroke and influenza and pneumonia. But for cancer, they dropped a meager 5 percent—to about 200 deaths a year per 100,000 people of all ages, and 1,000 deaths per 100,000 people over age 65. In comparison, the death rate from heart disease is only a third of what it was in 1950. Even though more people die of heart disease than from cancer, cancer deaths have been edging closer to heart disease deaths each year.

Paradoxically, according to a Time Magazine poll, almost as many respondents believe we are making great progress in curing cancer (74 percent) as believe this about curing heart disease (81 percent). It can be posited that improved detection at earlier stages of the disease has resulted in a greater number of people who are living with or have been cured from the disease, but the nearly flat death rate means we are still a long way from effective treatments—not to mention cures—for those who are sickest.

Which brings us to the "crusade against cancer," a phrase used by numerous charitable organizers and which, broadly construed, has undoubtedly helped shape public opinion about progress against the disease. Other slogans add to the heady mix: "We're in it to end it," says Avon, which sponsors a three-day walk in major cities around the country. Susan G. Komen for the Cure foresees "Ending breast cancer forever." The Lance Armstrong Foundation urges us to "Live Strong." And the venerable American Cancer Society (ACS) states its dedication to "eliminating cancer as a major health problem."

Charity Navigator, an independent charity evaluator, "works to advance a more efficient and responsive philanthropic marketplace by evaluating the financial health of more than 5,500 of America's largest charities." A search on its website using "cancer" as the keyword turns up 122 organizations that raise funds for everything from promoting awareness to funding research. And though the National Cancer Institute outspends all the charities combined, the money they raise is not trivial by any measure. ACS cites revenue of more than $1 billion for fiscal 2008. The Dana Farber Research Institute in Boston weighs in at about $800 million/year; Susan G. Komen is at almost $300 million. A sprinkling of lesser-known organizations such as the American Institute for Cancer Research, ASCO Cancer Foundation and Living Beyond Breast Cancer collect between $30 million and $50 million per year. More modestly, 93 of the 122 organizations spend less than $15 million each year.

In terms of area of emphasis, a rough count based on occurrence of the word in each organization's name reveals that breast cancer is the focus of about 10 percent of all cancer charities tracked by Charity Navigator, with skin/myeloma, leukemia, lung, ovarian and prostate, each with fewer than 5 percent of the total and pancreatic cancer receiving a single mention.

Charity Navigator uses a four-star system to rate overall efficiency of each organization at delivering promised services, and 75 cancer charities receive either a three- or four-star score. To briefly cite examples, Susan G. Komen for the Cure (four stars) distributes 83.4 percent of its revenues into its programs and spends only 7 cents raising funds for every dollar it collects. Its administrative expenses are also low at 10.5 percent. At three stars, the American Cancer Society spends about 20 cents to raise a dollar. The John Wayne Cancer Institute directs 61.4 percent of its revenue into programs, spends 32 percent on administrative expenses and receives a two-star rating. One-star and zero-star rated groups spend 25 percent to 75 percent on fundraising expenses with commensurate reductions in dollars invested in programs.

A final issue revolves around what each charity means by the term "programs." For example, Susan G. Komen for the Cure defines itself as "the world's largest grassroots network of breast cancer survivors and activists fighting to save lives, empower people, ensure quality care for all and energize science to find the cures." Does this phrase mean "dollars invested in promising research" or something else?

Of the several organizations queried at press time, only the Lance Armstrong Foundation responded, stating that it has invested $22 million in research since 1999.

Many organizations fund education and support of patients and families, but not research. For example, Living Beyond Breast Cancer provides "breast-cancer-related information, connection and support after completing treatment."  The six regional Gilda's Clubs provide similar services in support of the whole family, as do the renowned Ronald McDonald houses.  

All of this makes it difficult to determine the financial contribution of charities to cancer research while perhaps helping to explain why fervent optimism is so widely expressed. The acts of providing education and support to those stricken and their families virtually demand it. Or as Winston Churchill put it: "For myself I am an optimist—it does not seem to be much use being anything else."

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