If you’re looking for a century-old organization that can state “mission accomplished,” the American Cancer Society would not top the list.
The American Cancer Society set out in 1913 to bring cancer under control. This year or next, cancer is expected to become the No. 1 cause of death in the world.
But society executives and some experts say that such an analysis is too simplistic. They argue that the American Cancer Society has played an important role in changing behavior and developing therapies that have helped to limit the death toll from the complex disease.
In the 1950s, the group sponsored landmark research that established the link between smoking and lung cancer. That same decade, it started an education effort with the doctor who invented the Pap smear, which detects cervical cancer, to encourage women to get the test.
Throughout its history, the society has spent $3.5-billion on research and supported 44 scientists who have gone on to win the Nobel Prize.
Still, the group initially known as the American Society for the Control of Cancer is far from accomplishing its mission. The society set a goal in 1991 to reduce cancer mortality rates by 50 percent by 2015 (after controlling for the growing share of old people in the population). As of 2007, the latest year for which it has data available, mortality rates had dropped by only 17 percent.
“There will never be one cure for cancer,” says John R. Seffrin, the society’s chief executive. “It’s a constellation of many diseases, and there will be tailored medicines over time. But if we don’t solve the cancer problem fairly early in this century, it’s our own fault. We won’t have done what we know needs to be done.”
Fewer Deaths
Although the billions spent each year by the federal government on cancer research dwarfs the $135-million that the American Cancer Society spends on research, Mr. Seffrin argues that the society’s century of attention to the issue has been an important contributor in reducing death rates from cancer.
“Our paw prints are on every major advance of the last half century in terms of prevention, treatment, or cure of this disease,” Mr. Seffrin says.
Joel Fleishman, a professor of public policy at Duke University and an expert on philanthropy, agrees with Mr. Seffrin that the society deserves credit for the inroads made in discovering causes of cancer and treatments that prolong life.
“There is a correlation between the long-term existence of an organization like this and the extent to which they can develop momentum and achieve a lot of different things,” Mr. Fleishman says.
When the organization was founded by 15 physicians and business leaders in New York in 1913, a cancer diagnosis was almost certain to mean death. Early activities focused on education—in the 1940s, a group of volunteers known as the “Women’s Field Army,” complete with khaki uniforms, helped raise money and the public’s attention. Those efforts paved the way for the American Cancer Society to become the fund-raising powerhouse it is today.
In 2009 the society raised $897-million, ranking it seventh on the Philanthropy 400, The Chronicle’s list of organizations that raise the most from private sources.
Close to half that amount, more than $400-million in 2010, comes from what is widely thought to be the most successful event in American fund raising, the Relay for Life walkathon, which started in 1985 and is now held in 5,100 locations in the United States and 20 other countries.
The society is constantly tinkering with new strategies—it recently started a program called DetermiNation, in which endurance athletes train for an event like the marathon, often as a group, and raise money for the society in the process.
The society maintains roughly 500 local offices and 6,500 paid employees, many of whom help coordinate the Relay for Life events. (It is also assisted by 3 million volunteers.) The large staff results in fund-raising costs that eat up nearly a quarter of the society’s total income—far more than any other charity in the top 20 of the Philanthropy 400.
Greg Bontrager, the society’s chief operating officer, says many of the paid fund raisers are also providing education and calling attention to how to prevent disease. It is inappropriate, he argues, to compare the society with other groups that receive a majority of their donations in the form of goods (as do three of the groups in the Top 20.)
“We’re constructed for different purposes but measured on one efficiency scale,” he says.
‘Subtler’ Causes
For years, one of the society’s most vocal critics has been Samuel Epstein, an emeritus professor at the University of Illinois at Chicago, and founder of the Cancer Prevention Coalition. Dr. Epstein says that the society overemphasized the personal decisions that affect who gets cancer and played down environmental causes of cancer in the air, food, water, and workplace.
“It was entirely ‘blame the victim,’” Dr. Epstein says. “If you got cancer, it was your own fault: You smoked too much, ate too much, drank too much, or spent too much time in the sun.”
Over the past two years, according to Dr. Epstein, the American Cancer Society “got religion” and began to publish a few impressive studies on the environmental explanations for cancer.
Mr. Seffrin does not apologize for the society’s emphasis on actions that help people avoid cancer. He says research shows that 70 percent of cancers are preventable by improving diet, exercising, not smoking, and undergoing regular cancer screenings. Yet he also says he thinks the society’s investment in two long-term cancer-prevention studies, which track participants over decades until death, will help unearth some of the “subtler” causes of cancer, including environmental explanations.
Other Groups
For most of its history, the society was the only major charity raising money in the battle against cancer. But in the past few decades, other important players have emerged, including Susan G. Komen for the Cure, which focuses on breast cancer, and the Lance Armstrong Foundation, also known as Livestrong, which helps cancer survivors.
Society officials say the new groups are both competitors and collaborators—while the three organizations compete aggressively to raise money, they have also worked together on some projects. In August the society and Livestrong jointly released a report about the global economic costs of cancer. In the future, Mr. Seffrin plans to collaborate with Livestrong to better help cancer survivors. Livestrong represents the 28 million cancer survivors around the world, and the society tracks data on cancer survivors and their problems and needs, as far as a decade beyond their initial diagnosis. “Livestrong doesn’t need to repeat that research,” Mr. Seffrin says. “We’ve got it and we’ll share it.”
Mr. Seffrin says the society is working on a plan for how it can best use its money in the future, and the society could scale back its work in some areas where other organizations are focusing their efforts, such as Komen and breast cancer.
Focus on Faster Results
While the society may narrow its focus in some areas, it is expanding in others. The first Hope Lodge, which provides free housing to cancer victims traveling for treatment, opened in 1970; the society now operates 30 of them. The Quit for Life program, a partnership with the company Free & Clear, has worked with 1 million smokers since 2004.
The society’s boldest expansion came in 2006, when Mr. Seffrin persuaded the charity’s board that it should advocate for better access to health care for all Americans.
Mr. Seffrin pushed the strategy, even though it led to some donors defecting, after he saw research showing that a woman with Stage 1 breast cancer but no health insurance was more likely to die than a woman with health insurance who had more advanced stage 2 cancer.
The charity reallocated its entire advertising budget in 2007—some $15-million—to buy television commercials depicting cancer victims who had suffered due to inadequate insurance or none at all.
“The American public gives us $2.6-million every single day and says, ‘Do something about the cancer problem,’” Mr. Seffrin says. “We decided to leverage those resources to have maximum impact.”
The society is also considering making some major changes in its research support. With the federal government spending nearly $5-billion per year through the National Cancer Institute, primarily for basic research (plus hundreds of millions more through other agencies), the society is likely to begin focusing on research that can quickly lead to life-saving applications, Mr. Seffrin says.
The society estimates that due to the decline in death rates from cancer since 1991, an additional 716,000 people are alive in the United States today than would have been if the rates had stayed flat. Mr. Seffrin thinks that number could double or even quadruple in the next decade or two with some “game-changing” interventions.
“We need to hit home runs,” Mr. Seffrin says.
KEYS TO SUCCESS
Broadening services: The group now helps people quit smoking, a major cause of cancer, and provides lodging to needy patients who must travel for treatments.
Pursuing advocacy: To help cancer patients afford the care they need, the charity advocated for the health-care overhaul Congress passed last year.
Undertaking new ventures: It already runs one of the most lucrative fund-raising walkathons in the nonprofit world, but now it is expanding into other areas, such as trying to attract endurance athletes to help it raise money.