I take full responsibility: It was my “fault” that we built a very well-designed University of Hawaii Cancer Center building four months ahead of schedule and $17 million under budget; that we won the very competitive federal “National Cancer Institute (NCI) designation,” a privilege granted to only 65 cancer centers across the U.S.; that we recruited some of the best cancer researchers and pulled together the main Hawaii hospitals to partner with us; and that we were a success story all the U.S. cancer community talked about. It’s all my fault. (Actually, this is not true, as many people helped me achieve this success, but if you like to blame me for the success, please do so.)

When I was asked to take on the challenge, I was given the budget based on the cigarette tax revenues. I didn’t create the budget — that money was allocated and approved by the University of Hawaii and the state Senate. Then e-cigarettes were invented and our income generated by the cigarette tax decreased; although presently we have money, in a couple of years we will run out. Should I have somehow predicted the invention of e-cigarettes and not pushed to build a cancer center, win NCI designation and recruited top scientists to Hawaii? Really? Do you realize the nonsense of all this?

When I presented to the UH Board of Regents the plan to build the cancer center, then-Regent Dennis Hirota, asked me, What if people stop smoking cigarettes? How are you going to pay the mortgage and salaries? I got the same question when I presented the proposal to the state Senate.

I answered both times that to have a NCI-designated cancer center, we needed to build a new building and hire new faculty, and that, unfortunately, there was no sign that people would reduce smoking (e-cigarettes had not appeared yet) — but if that were to happen, it would be wonderful news as smoking is the No. 1 cause of cancer. As a cancer researcher, I could only hope that people stop smoking.

And I said, if that happens, the regents and the Legislature will have two choices: 1) Close the cancer center; 2) Increase the cigarette tax to make up for reduced revenue. That was true then, and it’s true now.

In my opinion, an NCI-designated cancer center is a priority, but it is up to the Legislature, the BOR and UH leadership to decide. If we want it, we need to pay for it.

It is wonderful news that people are smoking less: Many fewer will die of cancer, a terrible way to die. Still, many people will develop cancer because we live longer and cancer is a disease that mainly strikes old people. They deserve to have an NCI-designated cancer center here because of our isolated geographical location.

When someone develops cancer in Hawaii, she/he should have access to the best experts and the best therapies here, rather than having to fly to the mainland — assuming one can afford it. Hawaii should be able to pay $10 million more per year — $5 million is not enough — to run a competitive NCI-designated cancer center here; it is equivalent, for example, to an increase of 2 cents per cigarette on the cigarette tax.

It’s amazing to me that anybody could question that. Hawaii cannot afford $10 million yearly to offer better options to its residents to support a NCI-designated cancer center, when it is well established that NCI-designated cancer centers are the main tool to provide better programs for cancer prevention and to provide access to novel therapies. Really?

Michele Carbone, M.D., Ph.D., is a professor and former director of the University of Hawaii Cancer Center (December 2008 to December 2014).