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The war against cancer has stalled after $23 billion and 23 years of work - and poor health care and lack of coordination are mainly to blame, cancer experts told Congress.

"We have a schizophrenic system," said Dr. Paul Calabresi, chairman of the National Cancer Advisory Board. "New direction is urgently needed."Congress last year asked the board to uncover why, 23 years after President Nixon declared the war on cancer, the disease is still on the rise.

In a report Thursday called "Cancer at the Crossroads," the panel concluded that doctors have made tremendous progress against some forms of cancer and are finding cancer-causing genes and innovative treatments.

Still, one in every three Americans will get cancer and one in five will die of the disease. The overall mortality rate is 8 percent higher today than in 1971 and cancer is destined to surpass heart disease as the No. 1 killer in just five years.

The main problems, the panel said, are lack of health care, lack of direction for the National Cancer Program and a lack of money to get treatments that are sitting in laboratories to the doctor's office.

"For the first time, we have laid out the National Cancer Program for what it really should be," said Dr. Harold Freeman of the President's Cancer Panel. "If Congress fails, that's their burden."

The panel called for:

- A Cabinet-level cancer czar to coordinate work by the National Cancer Institute and other government agencies, hospitals and private groups.

- Universal access to state-of-the-art treatment. Most managed-care systems - and health reform plans - make victims settle for general practitioners instead of NCI-designated cancer centers and keep patients away from top treatments because they won't cover drugs that are still in clinical trials.

"You can have a little bit of diabetes. You don't have a little bit of cancer," Calabresi said. "Cancer has to be treated by specialists."

- Sufficient funding. Most importantly, NCI needs $60 million a year to move new discoveries into clinical trials, a bridge now almost totally neglected because money from drug companies and hospitals has disappeared, the panel said.

- An end to government support of tobacco, which NCI says causes one-third of all cancer deaths.