Toward Cancer Control

WHEN Mrs. Mary Brown, a plump, cheerful housewife from Dallas, had her first bout with breast cancer seven years ago, her doctors knew exactly what to do. Following the accepted procedure, they performed a radical mastectomy, removing the affected breast, the underlying muscle tissue and the nearby lymph nodes. Then they subjected her to intensive radiotherapy, hoping that the X-ray bombardment would kill any residual cancer cells. But when cancer recurred at the operation site two years ago, and raised reddish, golf-ball-sized lumps on the flat area where her left breast had been, the doctors were stymied. Surgery was out of the question; the lumps were evidence that the cancer had spread too far. So was X-ray treatment. Mrs. Brown (not her real name) had already had so much exposure to X rays that any more could do serious damage to her healthy tissues. Thus, when even anti-cancer drugs failed to halt the spread of the disease, Mrs. Brown turned in desperation to a new and still experimental treatment.

The treatment, called immunotherapy, uses a biochemical strategy designed to trick the body's own natural defenses into fighting cancer. In Mrs. Brown's case, doctors deliberately exposed her to attenuated tuberculosis bacilli, figuring that if they could make her body resist them, it might resist the cancer as well. The strategy worked. Shortly after treatment began, her lesions began to shrink and disappear. Today Mrs. Brown has only a few lumps on her chest. None of her doctors will say that she is cured, but all agree that without immunotherapy she probably would not be alive today.

Mrs. Brown's treatment is one of the most dramatic applications of the rapidly expanding science of self-immunology—the study of the body's natural defenses against disease. That science is one of the most promising weapons yet developed by doctors in their long fight against cancer, which this year alone will afflict an estimated 650,000 Americans and kill more than 350,000. The older techniques—surgery, radiation and chemotherapy (drug treatments)—have been used successfully in bringing some cancers under control. But surgery usually results in unsightly and handicapping mutilation, radiation can destroy healthy as well as cancerous tissue, and chemotherapy produces unpleasant and dangerous side effects. Immunotherapy, which so far seems to have none of these disadvantages, could thus prove to be the ideal approach.

Whether immunology fulfills this promise and becomes a major part of medicine's approach to cancer depends in large part on a harddriving, affable egotist named Robert Alan Good. A lanky (6 ft. 2 in.), generally rumpled man with an insatiable curiosity and an almost uncanny ability to assimilate any information that passes his way, Good, 50, is both a pediatrician and a Ph.D. in anatomy. He believes that immunology holds the key not only to controlling cancer but to preventing and curing many of man's other ills.

Good is the foremost student, practitioner and advocate of immunology in the U.S. today. His own research, most of it carried out at the University of Minnesota, has been responsible for much of medicine's current knowledge about how the immune system functions. His writings have helped spread the word about the new science; he is coauthor or editor of at least a dozen books on the