chance of the second breast developing cancer in
women previously diagnosed with the disease. How-
ever, the drug was also linked to increased risk of de-
veloping uterine cancer. Funding by Congress for re-
search into the disease was increased to over $300
million.
The rate of cancer mortality in general dropped
during the 1990’s, reversing a trend that had shown
an increase in the death rate during the previous
twenty years. The mortality rate for prostate cancer
among men of all ages dropped by greater than 6
percent; in men under age seventy-five, mortality
was reduced by 7.5 percent. The improvement was a
direct result of earlier diagnosis, with emphasis on
yearly digital examinations and increased reliance
on the blood test that measured prostate specific
antigen (PSA) levels.
Similar emphasis on examination and early de-
tection also accounted for decreased mortality of
other forms of cancer, including that of colorectal
cancer (7 percent), with improved diet being a con-
tributing factor, and several forms of lymphoma.
Even the trend associated with lung cancer, the most
common form of malignancy, showed improve-
ments. While persons over the age of sixty-five
showed an increase greater than 14 percent in mor-
tality associated with lung cancer, the direct result of
an increase in smoking associated with this genera-
tion, the mortality in both men and women under
age sixty-five showed a leveling in the rate, and by the
end of the decade, a slight reduction (4 percent) in
the mortality rate of the disease. In 1994, the FDA ar-
gued that tobacco companies “manipulated” the
concentration of nicotine in cigarettes, with the pur-
pose being to establish an addiction to cigarettes.
That year, the former head of research at one of the
major tobacco companies supported the FDA con-
tention by providing documentary evidence that not
only the nicotine content had been manipulated but
also that additional chemicals had been added to
cigarettes to boost the addictive effects of the nico-
tine.
One alleged cause of cancer was eliminated dur-
ing the decade. A report in 1992 had initially linked
the presence of electromagnetic fields (EMF) associ-
ated with power lines with increased risk of develop-
ment of a malignancy. Further analysis within the
Department of Health and Human Services showed
that no such relationship existed, and EMF posed no
cancer risk.
Health Care Reform The increase in research costs
during the 1990’s reflected a general increase in
costs of health care. However, estimates projected
that over thirty-seven million Americans had no
health insurance, with the number climbing as un-
ions lost much of their power and as jobs were elimi-
nated as a result of outsourcing. For businesses, the
cost of health care was estimated as greater than
$4,500 per year per employee. In 1993, President
Bill Clinton placed health care reform as one of
America’s highest priorities. The costs associated
with the pharmaceutical industry were among the
areas open to criticism. Clinton observed that on an
annual basis, pharmaceutical companies spend over
$1 billion more for advertising than they do on re-
search into newer drugs. President Clinton ap-
pointed his wife, First Lady Hillary Rodham Clinton,
to head a commission with the job of reforming the
system.
Among the opponents of reform as President
Clinton saw it was the health insurance industry.
Shortly after the commission was established, the
Health Insurance Agency of America began a series
of television advertisements that made light of the
attempted reforms. In the end, little was accom-
plished in the area of health care reform, and the is-
sue continued into the new century.Impact The decline in most forms of cancer con-
tinued into the twenty-first century. Mortality due to
breast cancer decreased an average of 2 percent an-
nually, with a decline averaging greater than 3 per-
cent in women under the age of fifty. Most of this im-
provement was the result of improved methods of
diagnosis; the five-year survival after diagnosis ap-
proached 90 percent by 2005. While the incidence
rate for diagnosis of prostate cancer in men re-
mained unchanged between 1990 and 2005, the
mortality associated with the disease was reduced
among white males from nearly 26 to 20 per 100,000.
Rates remained significantly higher among African
Americans but still demonstrated an improvement,
from 48 to 35 per 100,000. Mortality rates associated
with colorectal cancer leveled off during the ensu-
ing years but was half that reported during the
1970’s.
The safety of COX-2 analgesics was eventually
called into question. Both Celebrex, manufactured
by Pfizer, and Vioxx, produced by Merck, were asso-
ciated with increased risk of heart disease or stroke.The Nineties in America Medicine 559