Major Milestones Against Cancer

Major Milestones Against Cancer

The Cancer Progress Timeline is an interactive, data-rich resource that provides an historical overview of major advances in cancer that have led to better patient outcomes and quality of life. More than 400 milestones spanning 170 years are chronicled in the Timeline—from the advent of general anesthesia opening the door for cancer surgery in the mid-1800s to the first gene therapy for cancer approved by the Food and Drug Administration in 2017.

The Major Milestones Against Cancer Timeline highlights some of the most important advances across cancer care and research. Many of these milestones were supported by federal research funding, and nearly all of them are the result of rigorously conducted clinical trials, made possible by the participation of thousands of individuals with cancer. ASCO’s federally funded research badge is featured on milestones that stemmed from research funded at least in part by the National Cancer Institute or other federal agencies.

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1999

First targeted anti-breast cancer drug, trastuzumab (Herceptin), has major impact on care

First targeted anti-breast cancer drug, trastuzumab (Herceptin), has major impact on care

The FDA approves the groundbreaking drug trastuzumab (Herceptin) after research shows that adding the monoclonal antibody to chemotherapy dramatically increases survival for women with advanced breast cancer that over-produces a protein called HER2. In 2006, the drug is also approved as part of adjuvant therapy (after surgery) for women with early-stage HER2-positive breast cancer, after two major trials show that it reduces the risk of recurrence by more than 50 percent, an unprecedented result.

About 25 percent of breast cancer patients have HER2-positive disease, and prior to the introduction of trastuzumab, there were no effective treatments for these cancers, which were considered some of the most aggressive, deadly forms of the disease. Recently, trastuzumab was also FDA-approved to treat patients with stomach cancers that have a similar over-production of the HER2 protein.

1998

Chemotherapy before surgery helps more women benefit from breast-conserving treatment

Chemotherapy before surgery helps more women benefit from breast-conserving treatment

A major trial reports that an approach called neoadjuvant chemotherapy – providing chemotherapy before surgery – allows more than two-thirds of women with large breast tumors to undergo breast-conserving surgery, called lumpectomy, instead of full mastectomy. The goal of neoadjuvant therapy is to shrink tumors so they can be removed surgically. Breast-conserving surgery, also called lumpectomy, is easier to recover from and results in far better cosmetic outcomes – without compromising survival – compared with mastectomy. Neoadjuvant therapy is later shown to benefit patients with rectal and other cancers.

Treatment guidelines highlight obesity-cancer link
Drug therapy can reduce breast cancer risk in women at high risk

Drug therapy can reduce breast cancer risk in women at high risk

The FDA approves tamoxifen (Novaldex), a hormonal drug already used to prevent recurrence of breast cancer, to reduce the risk of developing breast cancer in women who are at high risk for the disease. The approval is based on a large trial showing that tamoxifen reduced breast cancer risk by more than 40 percent in women with a strong family history of breast cancer or with mutations in the BRCA1 and BRCA2 genes. Later research shows that a different drug used to treat osteoporosis, raloxifene (Evista), is as effective as tamoxifen at preventing invasive breast cancer, but with a lower risk of certain side effects.

New radiotherapy technique enables precise targeting of tumors near sensitive tissue

New radiotherapy technique enables precise targeting of tumors near sensitive tissue

Doctors begin using intensity modulated radiation therapy (IMRT), a highly advanced radiation technique, to precisely target tumors that lie close to vital organs and other sensitive tissue that must be protected from radiation. IMRT uses sophisticated software and complex new machinery to vary both the shape and intensity of radiation. One of the clearest benefits has been in the treatment of head and neck cancers; IMRT allows doctors to minimize radiation exposure to the spinal cord, optic nerve and salivary glands, reducing side effects without compromising tumor control.

1997

Prophylactic surgery helps prevent breast and ovarian cancers in women at high risk

Prophylactic surgery helps prevent breast and ovarian cancers in women at high risk

In the mid-1990s, researchers discover that women who have mutations in the genes known as BRCA1 and BRCA2 have a significantly increased risk of developing breast and ovarian cancers. Soon after, studies find that women with the mutations, or with a strong family history of these cancers, may be able to reduce their cancer risk by 90 percent or more by undergoing surgical removal of their breasts (mastectomy), ovaries (oophorectomy), or both. A decade later, a major review of published studies confirms that removal of the ovaries and fallopian tubes in premenopausal women with BRCA mutations reduces the risk of breast cancer by 51 percent and the risk of ovarian and fallopian tube cancers by 79 percent.

Surgery found to cure some patients with advanced colon cancer

Surgery found to cure some patients with advanced colon cancer

In general, metastatic cancer is difficult or impossible to treat with surgery because tumor cells are spread throughout the body. But in 1997, researchers find that some colon cancer patients whose cancer has metastasized to the liver only can be cured with surgery. In a study of nearly 300 such patients who underwent surgery between 1960 and 1987, about one in four were still alive five years later, and nearly of all of these patients were found to have been essentially cured. A later study finds that use of positron emission tomography, or PET scanning, can identify some liver metastases that would have gone unnoticed before, helping surgeons in the study to achieve a cure rate above 50 percent.

FDA approves first-ever targeted cancer drug, rituximab

FDA approves first-ever targeted cancer drug, rituximab

The FDA approves the first molecularly targeted cancer drug, rituximab (Rituxan), to treat patients with B-cell non-Hodgkin lymphoma that no longer responds to other treatments. Rituximab is in a new class of drugs called monoclonal antibodies, and targets a protein on the surface of immune cells known as B cells, interfering with the development of cancer. It is later combined with other cancer therapies to boost cure rates and increase survival.

1993

Taxanes emerge as a vital chemotherapy option for ovarian, breast cancer

Taxanes emerge as a vital chemotherapy option for ovarian, breast cancer

A new family of treatments debuts with the FDA approval of paclitaxel (Taxol) for advanced ovarian cancer. The drug receives one of the fastest-ever approvals, on the heels of data showing it shrinks ovarian tumors by more than half in many women who had stopped responding to all other therapies. Later studies show it extends survival by over a year when used as an initial therapy for advanced ovarian cancer, along with the chemotherapy drug cisplatin.

Over the next decade, paclitaxel also proves effective for all stages of breast cancer – extending lives and delaying disease progression compared to existing therapies, and delaying recurrence when used as adjuvant therapy (after surgery). The drug is derived from the bark of a yew tree, and is the product of a field of research exploring 'natural' cures for a range of diseases. Until drugmakers discovered a synthetic method for producing the drug, there was widespread concern that the natural resources needed to produce the drug would not meet demand.

Melanoma linked to sun exposure

Melanoma linked to sun exposure

A growing number of studies indicate that excessive sun exposure, including a history of severe sunburn, increases the risk of melanoma. However, researchers caution that some melanomas can occur in areas of the body without sun exposure, such as on the palms of the hands and soles of the feet. While researchers continue to seek a better understanding of melanoma's risk factors, a number of leading medical associations have cautioned against excessive sun exposure to reduce the risk of melanoma and other skin cancers.

1992

Sentinel lymph node biopsy determines cancer's spread with fewer side effects

Sentinel lymph node biopsy determines cancer's spread with fewer side effects

A surgical technique called sentinel lymph node biopsy becomes a less invasive way to assess whether cancer has spread in patients with early-stage melanoma, the most aggressive form of skin cancer. The procedure involves surgically removing the lymph node closest to the primary tumor – the "sentinel" node – and examining it under a microscope for evidence of cancer. If the sentinel node is cancer-free, no further lymph nodes are removed and the patient is spared the previous practice of removing a large number of nodes. This allows for easier recovery and reduces the risk of postoperative side effects such as lymphedema, a painful swelling of the extremities.

Sentinel lymph node biopsy is later found to be effective for women with breast cancer.

1991

Powerful anti-nausea drugs alleviate major side effect of cancer treatment

Powerful anti-nausea drugs alleviate major side effect of cancer treatment

Ondansetron (Zofran) is approved by the FDA to prevent vomiting caused by chemotherapy and/or radiation. The drug works by deactivating the nervous system's natural trigger for vomiting. Other, similar drugs are soon approved, including granisetron (Kytril), dolasetron (Anzemet) and palonosetron (Aloxi). These and other anti-nausea drugs, like aprepitant (Emend), make it possible for most cancer patients to receive chemotherapy in an outpatient setting, with minimal disruption to their daily routines.

Cancer deaths begin steady decline

Cancer deaths begin steady decline

For the first time since record-keeping began in the 1930s, cancer mortality rates begin to decline. The National Cancer Institute, the Centers for Disease Control and Prevention, and the American Cancer Society report that the overall cancer death rate fell by 2.6 percent between 1991 and 1995. Between 1991 and 2008 (the most recent year available), the death rate has fallen by a total of 18 percent.

1990

Shift to 3-D radiation treatment plans increases precision, safety of therapy

Shift to 3-D radiation treatment plans increases precision, safety of therapy

Thanks to the integration of powerful computers into medicine, doctors are able to dramatically improve radiation therapy by creating 3-D treatment plans. These plans require highly complex calculations and vastly more computing power than earlier, two-dimensional treatment plans. Thanks to this advance, radiation can be targeted at tumors from multiple angles, with beams of varying power, in ways that minimize the damage to healthy, surrounding tissue.

Laparoscopic surgery minimizes pain, recovery time for several cancers

Laparoscopic surgery minimizes pain, recovery time for several cancers

Beginning in the 1990s, laparoscopic surgery – in which a surgeon makes several small incisions and uses telescoping equipment to remove tumors – emerges as an alternative to traditional open surgery for some cancers, including kidney, prostate and colorectal cancer. This new approach allows patients to recover faster and experience less pain, without sacrificing effectiveness.

1989

Drugs to boost blood cells help patients finish cancer treatment, reduce infections

Drugs to boost blood cells help patients finish cancer treatment, reduce infections

The FDA approves the drug epoetin alpha (Procrit, Epogen) to stimulate production of red blood cells in patients with severe anemia, one of the most common and serious side effects of chemotherapy. These drugs are soon joined by white blood cell-boosting drugs such as filgrastim (Neupogen) and pegfilgrastim (Neulasta). The new treatments help reduce the need for blood transfusions and make chemotherapy safer by reducing the risk of infections and related hospitalizations.

1988

Benzene discovered to cause blood cancers

Benzene discovered to cause blood cancers

Scientists find that occupational exposure to benzene, a chemical commonly used as a solvent and in oil-related products, is associated with increased risk of developing non-lymphocytic leukemia, non-Hodgkin lymphoma, and other diseases. Following this discovery, workers begin taking steps to protect themselves from benzene exposure and reduce their cancer risk.

Adjuvant therapy proven for colorectal cancer

Adjuvant therapy proven for colorectal cancer

Pivotal clinical trials show that chemotherapy following surgery (adjuvant treatment) in patients with stage III colorectal cancer reduces the risk of cancer recurrence by about 40 percent. Later refinements – using newer drugs, radiation and sophisticated treatment schedules – help to lower recurrence rates even further. Together with greater screening to detect colon cancer early, adjuvant therapy has contributed to a 40 percent reduction in colon cancer mortality in the U.S. since the 1970s.

1986

Global guidelines help ensure proper pain management

Global guidelines help ensure proper pain management

Pain is common among patients with advanced cancer but hasn't always been well-managed. In 1986, the World Health Organization issues clear guidance on the use of pain medications for cancer patients, focusing on stronger, opioid-type drugs such as morphine. The guidelines address widespread concerns about addiction, tolerance and abuse, which made some providers reluctant to prescribe the drugs. Adherence to the guidelines has been found to provide reliable pain relief for up to 90 percent of patients. In later years, other organizations, including ASCO, propose guidelines to help doctors recognize and talk to their patients about pain and its management.

Tamoxifen reduces breast cancer recurrence
Second-hand smoke formally declared a carcinogen
PSA test enables early detection of prostate cancer

PSA test enables early detection of prostate cancer

The FDA approves the first PSA (prostate-specific antigen) test to screen for prostate cancer – the most common form of cancer in men – in men aged 50 and older. In the years that follow, widespread use of PSA testing leads to a significant jump in early-stage prostate cancer diagnoses, sparking debate about whether such screening improves survival or simply leads to diagnosis and unnecessary treatment of slow-growing cancers that would never have become life-threatening.

1982

Limited surgery helps rectal cancer patients avoid colostomies

Limited surgery helps rectal cancer patients avoid colostomies

A new procedure called total mesorectal excision emerges as a new standard surgical treatment for many patients with rectal cancer. The procedure involves removing only the cancerous region of the rectum, allowing patients to maintain normal bowel function. Previously, nearly all patients with rectal cancer had to undergo permanent colostomies (elimination of waste through an opening in the abdomen connected to a colostomy bag).

1981

First cancer vaccine prevents cancer-causing hepatitis B infection

First cancer vaccine prevents cancer-causing hepatitis B infection

The FDA approves the first vaccine against hepatitis B, one of the primary causes of liver cancer. In 1991, the U.S. begins routine vaccination of all children against hepatitis B, and by 2007, the number of acute hepatitis B cases among children under 15 years declines by 98 percent. Over time, routine vaccination is expected to reduce rates of liver cancer in the U.S. and globally among adults who were vaccinated as children.

1977

Growing use of mammography saves lives

Growing use of mammography saves lives

Regular breast cancer screening with mammography becomes increasingly common, helping to detect cancers at an earlier, more treatable stage. By the mid-1980s, nearly one-third of U.S. women over age 40 are screened. By 2008, the proportion screened approaches 70 percent. High screening rates – and resulting early detection – have contributed to a 27 percent reduction in breast cancer mortality among U.S. women since 1975.

Many women with breast cancer can opt for breast-conserving surgery

Many women with breast cancer can opt for breast-conserving surgery

Studies show that a procedure called lumpectomy – involving the removal of only the tumor, and not the entire breast – followed by radiation therapy is as effective as mastectomy for women with early-stage breast cancer. The finding helps dramatically reduce the physical and cosmetic side effects of breast cancer treatment and enables women to recover more quickly after surgery and return to their normal lives.

New treatments cure men with testicular cancer

New treatments cure men with testicular cancer

A pivotal trial shows that combining the drugs cisplatin, vinblastine (Velban, Velsar) and bleomycin (Blenoxane) can cure 70 percent of patients with advanced testicular cancer. Cisplatin is approved by the FDA the following year. Today, the overall cure rate for testicular cancer (all stages) is a remarkable 95 percent. 

1975

First adjuvant chemotherapy increases cure rates for early-stage breast cancer

First adjuvant chemotherapy increases cure rates for early-stage breast cancer

After overcoming concerns in the cancer community about whether the benefits outweigh the risks, Drs. Bernard Fisher and Gianni Bonadonna demonstrate that chemotherapy after surgery – known as adjuvant chemotherapy – prolongs the lives of women with early stage breast cancer. Their studies involve use of the drugs l-phenylalanine mustard or a combination of cyclophosphamide (Cytoxan), methotrexate and fluorouracil. Adjuvant chemotherapy becomes a major component of treatment for the disease, improving survival and cure rates in the years ahead. Today, about nine in 10 women with early-stage breast cancer are alive five years after their diagnosis.

This finding sets the stage for research on adjuvant therapy in other common cancers, including colon and lung cancer, making it one of the most important advances in modern cancer care.

Use of cancer-causing asbestos declines

Use of cancer-causing asbestos declines

As studies confirm long-suspected links between asbestos and certain cancers, use of asbestos begins to decline. In the 1980s, its use is banned in a growing number of applications, and environmental and health regulations help to dramatically limit exposure to asbestos in workplaces and homes. Asbestos exposure has been shown to increase a person's risk of lung cancer, mesothelioma (an aggressive cancer in the chest or abdomen), and other serious health problems. Because these problems often occur decades after exposure, however, the impact of preventive efforts will be felt gradually in the years ahead.

1974

CT scanning provides clearer images of tumors, guiding radiation and other treatments

CT scanning provides clearer images of tumors, guiding radiation and other treatments

Researchers perform the first computed tomography (CT) scan on a human patient – a woman with a suspected brain tumor. CT scanning uses X-rays to create images or "slices" of the brain, allowing doctors for the first time to clearly see tumors arising in the soft tissue of the brain. Over the following decades, CT scanning enables doctors to assess the size, shape and location of many other types of tumors, and to carefully target radiation and surgery to hit the tumors without harming healthy tissue.

1971

More limited mastectomy proven effective for early-stage breast cancer

More limited mastectomy proven effective for early-stage breast cancer

While radical surgery had been routinely used to treat breast cancer, a more limited surgical procedure called total mastectomy (removing just the breast tissue instead of removing the breast, chest wall muscle and underarm lymph nodes) is confirmed to be as effective for women with early-stage breast cancer. The procedure reduces pain after surgery and speeds recovery for patients. This advance paves the way for future breast-conserving surgeries.

National Cancer Act of 1971 becomes law

National Cancer Act of 1971 becomes law

President Richard M. Nixon signs the National Cancer Act in December, less than a year after launching a national "War on Cancer" in his State of the Union address. The act leads to a major expansion of cancer research efforts in the U.S., paving the way for much of the progress achieved over the next 40 years. Among other changes, the Act provides unprecedented levels of funding for the National Cancer Institute ($400 million in 1972 and $600 million by 1974) and directs NCI to expand federal cancer research facilities and award new research grants.

Screening tests for colorectal cancer dramatically reduce deaths

Screening tests for colorectal cancer dramatically reduce deaths

In 1967, the guaiac fecal occult blood test (FOBT) is introduced as a screening test for colorectal cancer, one of the most common forms of cancer. This simple and inexpensive tool detects the presence of blood in stool, a sign that cancerous or precancerous growths (called polyps) may be present. Within the next few years, two new screening techniques – flexible sigmoidoscopy and colonoscopy – enable physicians to examine the colon using a small camera attached to a flexible lighted tube. The widespread use of these approaches leads to better detection of precancerous polyps and early stage cancers that are usually curable with surgery. Over the coming decades, routine screening contributes to major reductions in colorectal cancer mortality – a total decline of more than 40 percent since 1975.

1970

Increased use of radioactive "seeds" to target prostate and other cancers

Increased use of radioactive "seeds" to target prostate and other cancers

Studies suggest that an approach called brachytherapy extends the lives of patients with prostate cancer, compared to surgical removal of the prostate and surrounding tissue. In this approach, tiny radioactive sources or "seeds" are implanted directly into the prostate gland, delivering a high dose of radiation directly to the tumor while leaving healthy tissue beyond the prostate relatively unaffected.

Brachytherapy has been used since the early 1900s, but became less common after the widespread adoption of external beam radiation. With refined techniques and conclusive data on its effectiveness, the approach once again becomes a central part of treatment for prostate, cervical and other cancers.

1965

Chemotherapy found to cure Hodgkin lymphoma

Chemotherapy found to cure Hodgkin lymphoma

Researchers led by Vincent DeVita discover that a new chemotherapy regimen called MOPP (mechlorethamine, vincristine, procarbazine and prednisone) cures up to 50 percent of patients with advanced Hodgkin lymphoma. This regimen quickly becomes the standard treatment. In the 1970s, a different chemotherapy combination (doxorubicin, bleomycin, vinblastine and dacarbazine – known as ABVD) proves even more effective, curing about 70 percent of patients with advanced Hodgkin lymphoma. The ABVD combination remains a mainstay of treatment today.

1960

Researchers link "Philadelphia chromosome" to leukemia

Researchers link "Philadelphia chromosome" to leukemia

Investigators in Philadelphia identify a chromosomal abnormality linked to many leukemias. A decade later, researchers discover that this abnormality results when parts of two chromosomes – chromosomes 9 and 22 – switch places in a phenomenon called translocation. It later becomes the target of one of the first-ever targeted cancer treatments, imatinib (Gleevec), which transforms treatment of chronic myelogenous leukemia and other cancers.

1959

Smoking linked to cancer; cessation campaigns begin

Smoking linked to cancer; cessation campaigns begin

In the 1950s, studies begin to show that smoking is a major cause of cancer, particularly lung cancer. In the early 1960s, both the U.S. Surgeon General and the U.K. Royal College of Physicians issue reports linking smoking to cancer and other serious health problems. In later years, smoking is also established as a major cause of pancreatic cancer, and second-hand smoke is declared a threat to the health of non-smokers. Tobacco control and smoking cessation soon become the most important strategies for reducing the worldwide toll of lung cancer.

1958

Pioneering "combination chemotherapy" cures leukemia

Pioneering "combination chemotherapy" cures leukemia

NCI scientists demonstrate that combination chemotherapy – in which multiple drugs are administered together – can cause remissions in both children and adults with acute leukemia. Their findings set the stage for nearly all modern chemotherapy, in which drug combinations, dosing and scheduling have been carefully refined to maximize effectiveness while minimizing side effects.

1955

U.S. government establishes national research network to test new cancer treatments

U.S. government establishes national research network to test new cancer treatments

The Clinical Trials Cooperative Group Program is established by the U.S. National Cancer Institute. Over time, this nationwide cancer research network proves the safety and efficacy of many of the most important advances in cancer treatment, screening and prevention. Cooperative Group trials have brought breakthroughs in adjuvant chemotherapy for breast and colon cancers; breast-conserving lumpectomy to avoid mastectomy; and new standards of care for blood cancers, brain tumors, and many others. Perhaps most striking is the impact of these trials on pediatric cancer survival rates. Fifty to 60 percent of children with cancer are enrolled in clinical trials, and childhood cancer survival rates have increased from less than 10 percent in the 1950s to nearly 80 percent today as a result.