To the Editor: I would like to respond to the "Unquiet Front" (HCR, May-June 2003). I read Andrew von Eschenbach's comments and heard them at the American Urological Association meeting in April. I did not get the impression that there would be a "cure" per se, rather the wise move to try and "eliminate suffering

and death" by turning cancer into a "chronic" disease. In an age when treatment is moving toward individualized therapy using rational drug design, and with the information from the human genome project at our fingertips, this is not so far-fetched. Finding a "cure" for all cancers is. The statements made in the early 1970s were naive and articulated without benefit of the information we have today. We now know and continue to learn that often the same cancer from person to person is actually quite different and thus therapies do not always work as predicted. Von Eschenbachs's statements are right on target in terms of the new goals we need to pursue. If we can refocus efforts to devise therapies to control rather than cure, we will make a dent in this disease. Additionally, to address the timetable of drugs from bench to market, von Eschenbach is working closely in partnership with the FDA to try and see how the process can work better--an unprecedented move by a director of the NCI.

There are two ways to look at the increase in cancer incidences between 1971 and 2003. The first, which seems to be the author's view, is that we are failing and losing the fight. The second view is that screening, diagnostic tools, and imaging devices have been refined so we now detect more cancers sooner, when the cure rate is high, rather than later when often there may be no hope. I don't know if von Eschenbach will make his goal; I hope he will. I think he is taking the right steps both on strategy and partnering with the FDA to speed up approval processes of promising new drugs. His arsenal is certainly much richer than in 1971. Let's wait and hope.

Julie Wilberding

Hagerstown, Md.