6. 40-year War on Cancer not going too well ● Age-adjusted death rate today not much different from rate in the mid-20 th century (rate rises from mid-century to 1991, then drops back after 1991). ● Post 1991 drop due largely to smoking cessation in men. Rate will continue to drop for a while as lung cancer rate in women will also drop. ● Lots of cancer increasing in incidence (prevention ineffective for most types of cancer). ● New molecular-target drugs not the cure we were hoping for (survival increase months/wks) ● Genetic studies indicate cancer much more complicated than hoped; dismal news.

7. When you eliminate the precancers, you don't get any cancers

8. IEN (IntraEpithelial Neoplasia) ● Not all epithelial precancers are intraepithelial (dysplastic lesions of kidney, thyroid, liver, adrenal gland) ● Not all precancers are epithelial (intratubular germ cell neoplasms, myelodysplasias, non- autonomous lymphomas) ● Not all intraepithelial neoplasms are precancers (seborrheic keratoses)

9. Consensus Definition ● NCI-GeoWash sponsored conference, November 2004 ● Summarized page 65

10. SEER AVG. AGE FOR CERVICAL NEOPLASIA, BY TYPE ● 34 years carcinoma in situ, nos ● 34 years squamous cell carcinoma in situ, nos ● 35 years sq. cell carcinoma, large cell, non-kerat, in situ ● 37 years sq. cell carcinoma, kerat, nos, in situ ● 39 years adenocarcinoma in situ ● 39 years squamous intraepithelial neoplasia, grade iii ● 41 years sq. cell carcinoma, micro-invasive ● 49 years sq. cell carcinoma, lg. cell, non-kerat ● 51 years sq. cell carcinoma, sm. cell, non-kerat ● 51 years sq. cell carcinoma, kerat, nos ● 51 years adenocarcinoma, nos

12. Arguments I've heard (Figment of my imagination) ● No such thing as precancers (just early cancers)

13. Arguments I've heard (Everything's OK) ● We're on a course to cure cancer. Let's not change horses in middle of river. ● Precancer research is adequately funded; actively pursued by Prevention Division. ● Precancer research has value, but it should not be prioritized above more fruitful areas of research.

14. Arguments I've heard (Impractical) ● Not practical to diagnose and treat precancers. There are too many of them. They're almost impossible to find. We just can't afford it. [My key points: Only proven way to eliminate cancer; Dx not required]

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