Significant progress has been made in terms of diagnosis and treatment, but should we have achieved more?
In 1971, Richard Nixon signed the National Cancer Act, effectively declaring a war on the prevalent and debilitating disease. While he hoped it would help find a cause and cure, over thirty-five years later, we have yet to definitively find either. Having worked in a cancer clinic, I’ve seen the medical advancements, but I also saw no shortage of new patients. So what progress have we made toward defeating cancer?
Death Rates Are Declining
According to the National Cancer Institute, the United States is making progress toward major cancer-related targets. This includes a decline in death rates for the four most common cancers—prostate, breast, lung, and colorectal—as well as for all cancers combined. While a cancer diagnosis used to mean a death sentence, almost half of all cancer patients will live for five or more years after their diagnosis. Furthermore, the rate of cancer incidence has declined since the early 1990s.
Smoking Rates Have Declined
Smoking causes about 30 percent of all cancer deaths in the U.S. The decline in new cancer cases is directly attributable to a decline in smoking rates. Although adult smoking rates have recently stagnated, they had been steadily declining for the past few years. Between 1997 and 2004, the percentage of adult men who smoked went from 27.6 percent to 23.4 percent; in women, it went from 22.1 percent to 18.5 percent.
Since the late 1990s, smoking rates among adolescents have decreased as well. In 2005, the most recent data point available, 23 percent of high school students smoked cigarettes, down from a high of 37 percent in 1997.
Cleaner Air, Less Cancer
Although I tend to look at the secondhand smoke glass as half empty—“only” 53 percent of nonsmokers are completely protected from the 250 toxic and carcinogenic compounds in secondhand smoke—this is a major advancement from only ten years ago. Since the 1990s, local and state legislation has made workplaces, homes, and public places smoke-free, despite the tobacco industry spending millions to defeat such legislation.
Major Tobacco Achievements, International
According to the World Health Organization (WHO), tobacco is the world’s leading preventable cause of death, killing over five million people annually. One-third of these deaths are from cancer.
Major steps are being taken to curb this cancer epidemic. Over 140 countries signed the Framework Convention on Tobacco Control (FCTC), the first international public health treaty. The signatories pledge to implement proven tobacco prevention steps including increased taxes, banning tobacco advertising, promotion, and sponsorship, and passing secondhand smoke policies.
These measures helped the smoking prevalence in Brazil fall from 32 percent in 1989 to 19 percent in 2007. Brazil has also seen a corresponding drop in cancer mortality—especially lung cancer in men.
Cancer Vaccines Developed and Disseminated
Chronic hepatitis B causes half of the world’s liver cancer deaths, but vaccinating children can prevent these deaths. The majority of deaths occur in developing countries, so it has been a priority of the WHO and other organizations to increase administration of the vaccine. Because of these efforts, the WHO estimates that, because of the vaccine, over 600,000 hepatitis B-related deaths that would have occurred in adulthood from liver cancer and cirrhosis have been prevented.
Another cancer-causing virus, the human papillomavirus, also has a vaccine. HPV causes cervical cancer, which kills more than 250,000 women each year; the development of the vaccine is a step toward reducing the incidence of this disease. This year, the Nobel Prize in Medicine was awarded to Professor Harald zur Hausen, Professor Emeritus at the German Cancer Research Center, whose basic research contributed to the link between HPV and cervical cancer.
Other “vaccines” are being developed—not to target a virus, but to help stimulate the patient’s immune system to attack the malignant tumor.
Molecular Advancements
The exact cause for cancer remains largely elusive, save for those well-known environmental exposures such as tobacco, asbestos, sun, arsenic, etc. However, advancements in genetics have elucidated certain genes that predispose an individual to cancer, as well as the fundamental changes that occur in cellular biology during carcinogenesis. These advancements will hopefully lead to improved preventative, screening, and treatment techniques.
Advances in Screening and Treatment
In the past few decades, there has been a widespread increase in screening techniques, such as mammograms, PAP smears, and PSA tests. For instance, the percentage of women over forty having a mammogram increased from 29 percent in 1987 to 70 percent in 2000. Early detection often means better, more effective treatment and survival outcomes.
Although a cure for cancer remains elusive and treatment expensive, there have also been major advances in the quality of treatment and options. Chemotherapy is less toxic than it used to be, and newer drugs selectively target cancer cells, rather than indiscriminately killing all cells. Surgery and radiation have improved so that there is less damage to surrounding tissue and greater accuracy. Participation in clinical trials has expanded and new, promising drugs are constantly being developed.
Social Acceptance
Perhaps one of the best things to come out of a bad situation is the increased social acceptability and support for people dealing with cancer. Whether it’s the yellow, LIVESTRONG bracelets, the cancer walks, such as the Susan G. Komen Race for the Cure, or the networking through support sites, books, and meetings, cancer does not have the stigma it used to in our society. Nor do people have to go through diagnosis, treatment, recovery, or caregiving alone.
Despite these advancements, some feel that our progress should be greater, as there are certain areas of prevention (namely, physical activity and overweight/obesity) where we have made declines, not improvements. Likewise, the tobacco industry outspends tobacco control by millions, the incidence rates of some cancers (bladder, melanoma, and brain) are increasing, and health disparities exist. The war on cancer will be a long one.
