Progress and challenges in the global effort against cancer

The new decade has given birth to a large number of new concepts in our approach to cancer. The progress in molecular technology that occurred in the 1980's is being transferred in the 1990's to the bedside. The practical clinical application of basic science innovations is aimed at prevention and curative treatment of cancer in all of its forms, and is becoming a central theme of cancer therapeutics. The progress to date reflects a climate that fosters a unity of basic and clinical investigations, for example, where an understanding of tumor genetics or molecular immunoregulation can translate into an innovative clinical approach such as gene transfer therapy. The challenges that we face in this new decade arise in part from progress in certain areas, such as the discovery of natural products that have important antitumor activity but a limited source, or the increasing incidence in AIDS-related lymphomas that has come about from antiretroviral therapy-induced prolongation of survival for AIDS patients. There are critical challenges from a lack of progress in other areas, as well. The challenge of developing curative therapies is surpassed by the need to prevent those cancers before they arise. The challenge of prevention, as exemplified by the link between lung cancer and smoking, is of paramount importance. The ultimate challenge placed before the global oncology community is to ensure that the fruits of modern technology are available to all who need them.