Nearly 40 years and $40 billion since the official launch of the "War on Cancer" in 1971, the conflict shows no sign of ending. Half of all men and a third of all women in developed nations will contract the disease, and more than one in four of their citizens will die from it.

Accounts of breathtaking advances in cancer research have come one after the other, but talk of imminent victory has grown muted. In recent years cancer deaths have dropped chiefly because fewer people are smoking and more are getting screened and treated for survivable cancers like those of the colon, cervix and breast. But cancer is showing up in neighborhoods and at ages where it used to be quite rare.

As a world-class athlete, Lance Armstrong is unique. As a survivor of advanced cancer, he is not. Of the 10 million cancer survivors in the United States today, one in 10 is under the age of 40. More people are being diagnosed at younger ages with unusual cancers, like the testicular cancer that afflicted Mr. Armstrong.

For several hundred years, it has been understood that certain dirty trades doomed their practitioners to an early death. The shortened lives and wizened bodies of miners, blacksmiths, printers and leather tanners were the stuff of literature, dark paintings or grim woodcuts. Dickens, Shaw and Marx wrote of the vile working conditions of girls and boys in print shops, foundries and metal works. Millers, miners, goldsmiths, potters and chimney sweeps were long understood to frequently contract cancer. Women who painted uranium onto watch dials at the beginning of the last century succumbed to disfiguring cancers of the mouth after transferring radioactive paint from their fingers to their lips.

By the 20th century, sitting behind a desk, dispensing medical advice or multi-tasking with the help of cell phones, computers and GPS devices seemed far safer ways to earn a living. But are they?

In the past decade, cancer has claimed more than half the men and women in science and medicine whose New York Times obituaries listed cause of death -- that's twice the rate of the rest of us. We're not used to thinking that doctors or scientists face greater odds of developing cancer and other diseases because of the way they earn their living. But more white-collar professionals of all types, including those we turn to for help in treating disease, are dying of ailments previously associated with blue-collar workers.

Ignoring the threat

From the start, the War on Cancer has made astonishing breakthroughs in finding and treating the disease, but it has left unscathed known carcinogens like radiation, benzene, asbestos and other toxic materials (including tobacco, until recently). Virtually ignored have been the incompletely tested 80,000 industrial chemicals found -- in infinite combinations -- in everything from cosmetics to carpet glue.

A long-awaited congressional report on asbestos is expected to be released this month that confirms the Environmental Protection Agency's failures to tell people about the hidden and continuing risks of cancer from exposure to home insulation. Five years ago, EPA Administrator Christy Todd Whitman tried and failed to declare a "public health emergency" because of the dangers posed by uncontrolled use of asbestos in Libby, Mont., where one of four residents has asbestos-related lung disease, a rate 100 times higher than the rest of us. The town was finally declared a federal Superfund site in 2002, long after public health officials became aware of the scope of this slowly unfolding disaster.

Vermiculite from the mines of Libby contains a form of asbestos that was widely used throughout the country in attic insulation and potting soil. Recently, the EPA posted a warning on its Web site to avoid exposure to vermiculite-based insulation. But there is no national campaign even now to spread information about this insidiously slow-acting hazard.

Today in Germany, France, Italy and the United States, one in three cases of mesothelioma, a rare cancer thought to be unique to asbestos exposure, occurs in people who have no history of working with asbestos. This tells us that people are being exposed who show no signs of disease for years.

Confront the suspects

One way to jump-start the effort to get rid of cancer-causing materials in the environment is surprisingly simple. We have to stop debating whether we have irrefutable proof that certain agents cause cancer in humans and start finding safer substitutes for suspected hazards. The Economist reported last month that America has lost its leadership in environmental policy. Europe is now leading the world in reviewing and restricting the use of toxic materials in commerce, placing American businesses at a competitive disadvantage worldwide.

Our regulatory system today looks at suspected cancer hazards -- whether CT scans, aspartame, cell phones or a new adhesive -- as protected trade secrets whose exposure in humans occurs only one substance at a time. This approach defies common sense and basic biology by assuming that just because a single agent may look all right when it has been tested in laboratory studies, we and our children can safely encounter hundreds of such materials mixed in countless ways. The studies exonerating aspartame, for instance, have all been conducted on older adults who have used the product late in life; they do not address the potential impact of aspartame or aspartame mixed with other materials on children who have consumed the product since infancy.

Prescription drug companies look for drug interactions and issue warnings about combining medications. Regulators need to adopt a similar approach to environmental hazards. We must address the combined risks of tiny amounts of hazardous agents, many of which our children regularly encounter and many of which did not exist even 30 years ago.

While we improve our ability to calculate risks, we also should replace suspect materials and processes with safer ones, such as those being developed through green chemistry and design at Carnegie Mellon University and the University of Pittsburgh's Mascaro Sustainability Initiative. Medical centers already are taking action, launching massive efforts to rid buildings and grounds of proven and suspected toxic agents. We are doing this not because we know it will reduce the incidence of cancer, but because, as professionals who have devoted our lives to fighting this disease, we strongly believe it will. Like Hackensack Medical University, Beth Israel Hospital, Kaiser Permanente and others, the University of Pittsburgh Medical Center is encouraging our more than 400 medical facilities to use fewer toxic materials and safer forms of transportation, energy and disposal.

Open the files

To break the logjam of narrow-minded regulation and the backlog of testing on individual products, we should create a national Truth and Reconciliation Commission modeled on the one that brought to light the abuses of apartheid in South Africa while holding harmless most of those who committed human rights violations.

Producers of the myriad modern products that may be hazardous would have to open their testing and workplace-health files to independent examination. A fee could be levied on them to help fund a truly independent forum where information about potential environmental hazards could be safely exchanged and where the risks and benefits of their products could be more thoroughly assessed.

Some will find this idea naive. But the reality is, the harder we try to exact vengeance against those who have caused harm, the more incentive they have to conceal information and the more harm will be done. If we want the world of the future to be healthier than that of the past, we can start by ending the protection of toxic trade secrets and by taking a more realistic look at the combined impacts of modern agents on our lives.

As Einstein noted in another context, we can't solve the problems of the present by repeating the mistakes of the past.