Mar. 29

　　In the course of a few days, both Elizabeth Edwards, wife of Presidential candidate John Edwards, and White House spokesman Tony Snow revealed that they are not just battling recurrences of cancer but also contending with malignancies that have spread and are no longer curable. Many Americans were stunned to hear that the Edwardses will continue their quest for the White House, with Elizabeth campaigning despite metastatic breast cancer. Snow, who was treated for colon cancer two years ago and now has tumor cells on his liver, will take time off but expects to return to his post.

　　Fellow cancer patients and their doctors are less surprised by such decisions to "push forward with the things you were doing yesterday," as Edwards put it in a 60 Minutes interview. Reason: in recent years the treatment of what used to be dismissed as terminal cancer has shifted from a win-or-lose battle against acute illness to something more akin to managing a chronic disease ― in many cases with extended periods of feeling just fine.

　　"To us it's a great sea change in the way people look at cancer," says Dr. Daniel F. Hayes, clinical director of the breast oncology program at the University of Michigan Comprehensive Cancer Center. Hayes says that he and fellow oncologists are enthusiastic about the example Edwards is setting. "From our standpoint, we spend a lot of time trying to make it clear that while cancer ― especially metastatic breast cancer ― won't just go away, you can still live a long and productive life with it."

　　The change in managing cancer reflects a series of hard-won improvements in treatment ― not, alas, for every form of cancer, but particularly for breast, colon, prostate and even lung. The gains include an explosion of new drugs that are more targeted and less toxic than old-school chemotherapeutic agents. In addition, new tests are beginning to help doctors match drugs more precisely to the genetic and molecular makeup of an individual tumor. Finally, there are remarkable advances in managing the side effects of treatment, which, in the past, could be as debilitating as cancer itself.

　　According to the American Cancer Society, the percentage of people living five years after a diagnosis of any type of cancer barely budged from 50% in the mid-1970s to 52% in the mid-'80s, but it shot to 66% for patients with a diagnosis after 1995 and is continuing to rise. For breast cancer patients the five-year survival numbers leaped, from 75% in the '70s to nearly 90% by 2002.