I like John Edwards and tend to agree with him on poverty and campaign finance, although his Iraq war opposition is weak and ambiguous. But he's got a lot of company there, unfortunately. The one thing you can say about the Republican candidates is their pro-war stance isn't ambiguous. It is explicit -- disgustingly so. But that's not what this post is about. It's about different Edwards disappointment, his newly announced position on cancer policy. For someone who was a plaintiff's lawyer in tort cases and whose wife is a cancer patient, his policy is mostly silent about a public health approach -- cancer prevention.
"I'm going to propose a national strategy for cancer survivorship," said Edwards. "It's a new way of thinking about cancer."He said five-year cancer survivorship now stands at 66 percent, a 50 percent increase over 30 years ago. That's progress, but more needs to be made, he said.
Under the package being outlined by Edwards, he would:
- Push for a substantial increase in funding for cancer research conducted by the National Institutes for Health. He put no specific figure on the increase, but said only two of 10 research projects now get funded by the federal agency.
- Expand testing and reporting of chemicals that may increase cancer risks, as well as monitoring where they may exist.
- Launch a national research program to identify environmental risks, as well as promoting lifestyle changes that could reduce risk. Those include smoking cessation, improving diets at schools and bolstering exercise to combat obesity.
- Increase support for respite care, including home visits from nurses and other health professionals to give caregivers a break. He also calls for an Internet clearinghouse for information about services that are available for families dealing with the disease. (Los Angeles Times)
Clearly this isn't primarily about cancer prevention (the NIH strategy is geared toward therapy and diagnosis), although testing and reporting of chemicals is part of a public health program. But it's the only nod to a preventive strategy. Mostly it's about curing cancer already contracted. Very little (and in passing) about finding and eliminating environmental causes of cancer. His examples put the burden on individuals to make "the right" choices. Nothing about crafting and enforcing regulations to keep carcinogens out of our air, water, food and soil. Nothing about finding alternatives and substitutes.
As a say, a disappointment. Sigh.
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People are going to get cancer. Why do you have a problem with trying to cure cancer once contracted? Perhaps you have data you can share on the percentage of cancer attributable to preventable causes? (we can, of course, stipulate to the benefits of smoking cessation.) IMH(professional)O, most cancer is the result of simple molecular bad luck. People have a philosophical objection to this viewpoint however because it is natural to want to find "the cause" of something, so that fault and/or blame can be assigned, and so that the world doesn't seem to be a capriciously random place, and to give the illusion that we can have some control over significant negative events.
Revere may have a better answer, but being curious I had a quick look for evidence about percentage of cancer attributable to preventable causes. For colon cancer in US men, studying ~48k men, Platz et al estimated population attributable risk by various methods getting 71% by one method (the method sounds reasonable to me, though I'm no expert).
Proportion of colon cancer risk that might be preventable in a cohort of middle-aged US men
Platz E.A.; Willett W.C.; Colditz G.A.; Rimm E.B.; Spiegelman D.; Giovannucci E.
Cancer Causes and Control, Volume 11, Number 7, July 2000 , pp. 579-588(10)
WHO is quoted in the press as saying 40% of all cancer worldwide is preventable, in conjunction with their ?forthcoming Global Action Plan Against Cancer, but I didn't find information about what that really meant and what data it was based on.
The first commenter got almost everything wrong in his silly opinion that he dares to call "professional".
> People are going to get cancer. Why do you [Revere] have a problem with trying to cure cancer once contracted?
Misreading of the post, Revere is only arguing that increasing prevention lowers the volume of subsequent treatments. In other words, preventing cancer is the best way to treat it.
> Perhaps you have data you can share on the percentage of cancer attributable to preventable causes? (we can, of course, stipulate to the benefits of smoking cessation.)
WHO World Cancer Report and other WHO sources indicate a 40--50% (total for all cancer sites). Some localisations are more sensitive to external risk factors and the figure will be higher for them (lung, larynx, oesophagus, are obvious examples).
> IMH(professional)O, most cancer is the result of simple molecular bad luck.
Then your opinion is not as professional as you think it is.
Once you get past smoking, known environmental toxins, and some rare cancers with clear genetic links, it becomes difficult to identify clearly modifiable risk factors. Known genetic bases for breast cancer account for a very small proportion of cases. there is inferential data from case control studies and cross national research that suggests that diet is important, but dietary intervention shave tended to be relatively disappointing in their effects. Over time, I've seen widely varying numbers (mostly based on selective review of the literature) regarding the number of cancer cases that can be prevented. I wouldn't put much stock in any of them, regardless who publishes them.
There's nothing innovative in Edwards' plan, but nothing imprudent Revere offers no new vitsa, either.
Rich: alcohol intake?
All: Estimates of the proportion of cancer deaths that are environmental or occupational vary widely, going from a low of 1 - 2 % (the chemiocal company preferred number) up to 40% (an NCI estimate from the early 80s). Reull Stallones, former Dean of U. of Texas Sch. of Public Heaalth (now deceased) did an independent estimate for the chemical industry and guessed at 20%. The number one sees most often is about 10% (half and half environmental and occupational), derived from the pretty conservative Doll-Peto paper of 1981. I've written at more length about this on the old site, but for now let's just go with the 10% number. Doesn't sound like much (90% are diet, lifestyle, etc.) but at 1500 cancer deaths a day it is 150 environmental/occupational cancer deaths a day, roughly the same or more as motor vehicle deaths and if it were a mine cave in or scaffold fall would make headlines in every newspaper in the country and we wouldnt be talking about just accepting them.
The problem is to identify the agents in the workplace or community environment that cause these cancers, and that is where Edwards could have said something: generic carcinogen standards, workplace enforcement, regulations, and much else.
My problem with Edwards's proposal was not what was in it but what wasn't in it.
Edwards does make a useful contribution by saying we need to regulate carcinogens and monitor their use better, but trying to estimate the percentage of cancers that would be prevented is a hopeless task, and it misses the point. The main goal is to reduce cancer by whatever means feasible, including tobacco control, healthy food, reduction of carcinogenic exposures at work, judicious exposure to ultraviolet light (which causes the most common cancer of all), etc.
As Revere points out, Edwards doesn't address the most fundamental issue in health care (including cancer care), e.g., the for-profit health care system. Only Dennis Kucinich has taken this on, quoted in an op-ed by Derrick Jackson in today's Boston Globe: "With 46 million Americans without any health insurance at all and another 50 million underinsured, isn't it really time to look at the other models that exist that are workable for all the other industrialized nations in the world? When you think about it, the only thing that's stopping us is the hold that the private insurers have on our political system." Kucinich considers his position the mainstream and all the other candidates to his right on this most important domestic issue. He told the Globe editorial staff "If people clearly understood that by going to vote on election day they would create conditions where they would have health coverage, if you could communicate that message, you wouldn't have to talk about anything else." (presumably on domestic issues)
As Sam points out, trying to estimate the number of cases of cancer that are preventable misses the point, and would be exceedingly difficult, but reducing cancer should be our first goal from both a financial stance, and for the well-being of US citizens. There are many cancers that could be prevented through environmental awareness and action. One simple example is radon. Exposure to radon in the home is the leading cause of lung cancer in non-smokers and is completely preventable. If every home in America was tested (test kits run around $20) and vented if needed, we could eliminate roughly 24,000 lung cancer deaths a year, and the consequent heartache and medical costs, from just one simple environmental action. I agree that addressing our "for-profit" health care system needs to be addressed at the outset. We only rank number 42 in life expectancy despite spending 25 percent more than any other country on the planet for health care. Instead of re-inventing the wheel, should we perhaps not consider how 41 countries in the world have a higher life expectancy and lower infact mortality, at less cost? Lynne Eldridge MD, Author, "Avoiding Cancer One Day At A Time: Practical Advice for Preventing Cancer" www.avoidcancernow.com
Arsenic, Rice & Ground water.
revere this seems up your street, is it as big a problem as the article implies? The numbers are confusing in that where they are sprinkled in the article they do not relate in a way that allows calculation.
http://news.bbc.co.uk/2/hi/science/nature/6968574.stm
What makes me nuts about focusing on treatment rather than prevention is that an improvement in Americans' lifestyles would have a major impact on our health in general, not just cancer. Eating a better diet helps prevent heart disease and diabetes, not just cancer. Staying out of the sun prevents premature wrinkling, not just skin cancer. Not smoking helps prevent emphysema, not just lung cancer. Americans have got to get better about this stuff at a younger age and not wait until the first heart attack.
Revere, all the best to you and your wife.