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All of us concerned about cancer were buoyed by last month's release of statistics from the American Cancer Society demonstrating another decline in U.S. cancer mortality.
Some highlights of this report include:
- Cancer death rates have decreased by 1.8% per year in men and 1.6% per year in women during the last five years for which data are available (2004-2008).
- The most impressive declines in cancer death rates were observed in African American and Hispanic men—over 2% per year.
- Death rates continued to decline for the big four cancers—lung, colorectal, breast and prostate. The biggest gains were seen in women with breast cancer whose 5 year survival rose from 75% in 1975-1977 to 90% in 2004-2007 and men with prostate cancer whose 5 year survival increased from 68% to nearly 100% over the same time frame. Even the five year survival for lung cancer improved slightly from 12% to 16%, a meaningful result for the 226,000 individuals who will receive that diagnosis in 2012.
- The reduction in cancer death rates since 1990 in men and 1991 in women has translated into the avoidance of over 1 million deaths from cancer in the United States.
We can be justly proud of these inroads, which reflect a combination of prevention (largely through tobacco avoidance), early diagnosis because of screening and awareness, and improved treatment. But our celebration should be brief and subdued because there is much to do. It is predicted that 1.6 million people in the U.S. will be diagnosed with cancer and 577,000 individuals will die the disease in 2012. We in the Commonwealth of Pennsylvania will account for 78,000 diagnoses and nearly 29,000 of these deaths.
What will we need to do to accelerate our progress? Here are a just a few goals that we must share in 2012 and beyond.
- We must continue our quest for scientific discovery. In my view, it is no coincidence that the declines in cancer mortality began within a few years of the signing of the National Cancer Act in 1971. These gains have come about in part because of our relentless efforts to translate our understanding of the vagaries of the cancer cell into molecularly informed approaches to cancer care. We simply cannot afford to reduce our focus on the translation of good science into good medicine at this critical time.
- Evidence-based approaches for cancer screening must be widely embraced by patients, doctors, and payers. Our ongoing refinement of screening guidelines cannot be an excuse for us to fail to apply established methods for early detection of common cancers like breast and colon cancer.
- We should assure equitable access to high quality cancer care for all who receive this diagnosis. Simply applying what we already know to all segments of the population will improve outcomes--the uniform application of effective approaches to all in need and the avoidance of approaches that have not been shown to help.
This must also be a year where we commit to the most effective strategy of all to reduce morbidity and mortality from cancer —prevention. There is not much we can do about the most common risk factor for cancer—increasing age. But there is much that each of us can do to minimize our personal risk. Foremost is the avoidance of all tobacco products—cigarettes, cigars, chewing tobacco, etc. So many cancers are more common in smokers—lung, head and neck, pancreatic, and cervical cancer to name just a few. It is increasingly clear that obesity is also a risk factor for diseases like postmenopausal breast cancer. Maintenance of a normal body mass index is vital for good health, contributing to decreased risk for the diagnosis of cardiovascular disease and cancer, the two biggest killers for Americans in the 21st century. It is also growingly apparent that alcohol use contributes to cancer risk—yet another reason to consume alcohol sparingly or not at all. Finally, we should make prevention strategies with documented benefits available to all—interventions like tamoxifen or raloxifene for breast cancer prevention in high risk women or preventive surgery for individuals who are carriers for mutated cancer genes like BRCA1 or the HPV vaccination for young men and women to prevent cervical and potentially head and neck cancer. Prevention approaches have been the cornerstone for the steep decline in cardiac deaths over the last 50 years and we who work in cancer should do no less.
Although I have focused on cancer statistics as we begin 2012, the scourge of cancer is all about people—those who are diagnosed, those who survive and those who sadly succumb. For us at University of Pittsburgh of Cancer Institute and UPMC CancerCenter, it is also about our people, the members of our team who are committed to moving discovery about cancer from the lab to the clinic to the community to minimize the burden of cancer for all.