The discovery that we are, as one investigator phrased it, living in a "sea of carcinogens" is of course dismaying and may easily lead to reactions of despair and defeatism. "Isn't it a hopeless situation?" is the common reaction. "Isn't it impossible even to attempt to eliminate these cancer-producing agents from our world? Wouldn't it be better not to waste time trying, but instead to put all our efforts into research to find a cure for cancer?"

When this question is put to Dr. Hueper, whose years of distinguished work in cancer make his opinion one to respect, his reply is given with the thoughtfulness of one who has pondered it long, and has a lifetime of research and experience behind his judgment. Dr. Hueper believes that our situation with regard to cancer today is very similar to that which faced mankind with regard to infectious diseases in the closing years of the 19th century. The causative relation between pathogenic organisms and many diseases had been established through the brilliant work of Pasteur and Koch. Medical men and even the general public were becoming aware that the human environment was inhabited by an enormous number of microorganisms capable of causing disease, just as today carcinogens pervade our surroundings. Most infectious diseases have now been brought under a reasonable degree of control and some have been practically eliminated. This brilliant medical achievement came about by an attack that was twofold - that stressed prevention as well as cure. Despite the prominence that "magic bullets" and "wonder drugs" hold in the layman's mind, most of the really decisive battles in the war against infectious disease consisted of measures to eliminate disease organisms from the environment. An example from history concerns the great outbreak of cholera in London more than one hundred years ago. A London physician, John Snow, mapped the occurrence of cases and found they originated in one area, all of whose inhabitants drew their water from one pump located on Broad Street. In a swift and decisive practice of preventive medicine, Dr. Snow removed the handle from the pump. The epidemic was thereby brought under control - not by a magic pill that killed the (then unknown) organism of cholera, but by eliminating the organism from the environment. Even therapeutic measures have the important result not only of curing the patient but of reducing the foci of infection. The present comparative rarity of tuberculosis results in large measure from the fact that the average person now seldom comes into contact with the tubercle bacillus.

Today we find our world filled with cancer-producing agents. An attack on cancer that is concentrated wholly or even largely on therapeutic measures (even assuming a "cure" could be found) in Dr. Hueper's opinion will fail because it leaves untouched the great reservoirs of carcinogenic agents which would continue to claim new victims faster than the as yet elusive "cure" could allay the disease.

Why have we been slow to adopt this common-sense approach to the cancer problem? Probably "the goal of curing the victims of cancer is more exciting, more tangible, more glamorous and rewarding than prevention," says Dr. Hueper. Yet to prevent cancer from ever being formed is "definitely more humane" and can be "much more effective than cancer cures." Dr. Hueper has little patience with the wishful thinking that promises "a magic pill that we shall take each morning before breakfast" as protection against cancer. Part of the public trust in such an eventual outcome results from the misconception that cancer is a single, though mysterious disease, with a single cause and, hopefully, a single cure. This of course is far from the known truth. Just as environmental cancers are induced by a wide variety of chemical and physical agents, so the malignant condition itself is manifested in many different and biologically distinct ways.

The long promised "breakthrough," when or if it comes, cannot be expected to be a panacea for all types of malignancy. Although the search must be continued for therapeutic measures to relieve and to cure those who have already become victims of cancer, it is a disservice to humanity to hold out the hope that the solution will come suddenly, in a single master stroke. It will come slowly, one step at a time. Meanwhile as we pour our millions into research and invest all our hopes in vast programs to find cures for established cases of cancer, we are neglecting the golden opportunity to prevent, even while we seek to cure.

The task is by no means a hopeless one. In one important respect the outlook is more encouraging than the situation regarding infectious disease at the turn of the century. The world was then full of disease germs, as today it is full of carcinogens. But man did not put the germs into the environment and his role in spreading them was involuntary. In contrast, man has put the vast majority of carcinogens into the environment, and he can, if he wishes, eliminate many of them. The chemical agents of cancer have become entrenched in our world in two ways: first, and ironically, through man's search for a better and easier way of life; second, because the manufacture and sale of such chemicals has become an accepted part of our economy and our way of life.

It would be unrealistic to suppose that all chemical carcinogens can or will be eliminated from the modern world. But a very large proportion are by no means necessities of life. By their elimination the total load of carcinogens would be enormously lightened, and the threat that one in every four will develop cancer would at least be greatly mitigated. The most determined effort should be made to eliminate those carcinogens that now contaminate our food, our water supplies, and our atmosphere, because these provide the most dangerous type of contact - minute exposures, repeated over and over throughout the years.

Among the most eminent men in cancer research are many others who share Dr. Hueper's belief that malignant diseases can be reduced significantly by determined efforts to identify the environmental causes and to eliminate them or reduce their impact. For those in whom cancer is already a hidden or a visible presence, efforts to find cures must of course continue. But for those not yet touched by the disease and certainly for the generations as yet unborn, prevention is the imperative need.