On February 2nd, President Biden announced a ‘moonshot’ to fight cancer. He also included the fight against cancer in his "unity agenda," announced during the State of the Union of March 1st.
Biden's goal is to cut cancer death rates in half over the next 25 years. While the news is welcome, the reality is that our half century war on the disease of cancer has had its successes and failures. Currently, cancer claims the lives of almost 600,000 Americans every year (second only behind cardiovascular disease) and over 10 million people each year (1 in 6 deaths) worldwide.
According to the American Cancer Society, the individual risk, in your lifetime, of having a cancer diagnosis is one in two for men and one in three for women. It is the cause of death for one in five Americans.
Much has been made about the reduction in cancer deaths over the last 50 years. What many people don’t realize is that most of that success comes from the decrease in smoking, i.e. a reduction in lung cancer deaths. Without that factor, those successes look very different in comparison to the 1930s when these data started to be tracked:
That is not to say that we have not seen remarkable progress in some areas such as childhood cancers and previously untreatable conditions like metastatic melanoma due to therapeutic advances like immunotherapy. These remarkable improvements have hidden, and in some ways have giving people a false sense of security, regarding our success in this ‘battle’.
The two most impactful things which can add years to an individual’s life (not to mention avoiding the associated mental and physical trauma associated with a diagnosis of cancer) are primary prevention and early detection.
According to the National Cancer Institute and World Health Organization, almost half of all cancers are preventable. Let me state that again: almost half of all cancers are preventable. How? By doing some very simple things:
Stop (or never start) Smoking
Maintaining a Healthy Weight
Moving Every Day
Limiting Alcohol Intake
Eating a Plant Heavy Diet
We tend to look at the above strategies as, "OK that’s very nice but I want to be sure about that magic bullet if I get it." But when it comes to prevention, there is no other therapy that has the cure rate than never getting the disease in the first place. What price would you pay for a drug that would cure your cancer or ensure that you never got it in the first place? By following the above five steps that can be achieved. As a society, however, we unfortunately and sadly tend not to think of it that way.
Still, take a look at the numbers. According to the American Cancer Society:
Cigarette smoking accounted for 19% of all cancer cases and nearly 29% of cancer deaths
Excess body weight was responsible for 7.8% of cancer cases and 6.5% of deaths
Drinking alcohol was linked to 5.6% of cancer cases and 4% of deaths
UV radiation was attributable to almost 5% of cases, but a lower 1.5% of deaths
Physical inactivity played into 2.9% of cases and 2.2% of deaths
When the researchers grouped together the related issues of excess body weight, alcohol intake, poor diet, and physical inactivity, they found this set of risks was responsible for a total of about 18% of cancer cases and 16% of deaths.
Depending on the study, up to 20% of all cancer cases can be prevented by a focus on improved nutrition. According to the Cleveland Clinic, this includes the following six tenets:
1. Go Mediterranean
A Mediterranean diet focuses on eating plant-based foods.
Fruits and vegetables
Whole grains
Healthier fats, such as extra virgin olive oil, nuts and seeds
Lean sources of protein, such as poultry, fish and legumes
It also involves limiting:
Red meat
High-fat dairy
Added sugars
Saturated fats
The Mediterranean diet has been linked to cancer prevention and other positive impacts on long-term health. And high-fiber diets like the Mediterranean diet are associated with a decreased risk of colon cancer.
2. Eat at least five to nine servings of fruits and vegetables each day
“Eat the rainbow” is a good rule of thumb, according to The American Cancer Society, which explains that the pigment that gives fruits and vegetables their color has ingredients that may reduce cancer risk.
To incorporate more plants into your diet, try to:
Eat at least three different colors of fruits and vegetables each day.
Make at least 50% of your plate fruits and vegetables (more vegetables than fruit). Split the other half between lean or plant-based proteins and whole grains.
3. Limit added sugars
When it comes to cancer, some view sugar as public enemy No. 1. Watch out for the usual suspects — sugary beverages, candies and desserts — as well as “healthier” foods that contain added sugars:
Breads
Crackers
Granola bars
Salad dressings
4. Cut down on alcohol
Alcohol use is associated with an increased risk of esophageal, throat and breast cancer. People who drink a lot of beer also have an increased risk of rectal cancer. And people with alcohol use disorder have increased incidences of liver cancer.
5. Go easy on the salt
Avoid cured, smoked and nitrite-preserved foods. International studies reveal higher incidences of stomach and esophageal cancers in people who consume large amounts of these products.
6. Take vitamin D supplements (1,000 to 2,000 IU daily)
Low levels of vitamin D are associated with an increased risk of breast, colon and pancreatic cancer.
Early detection of cancer
So, the first step is to never get the disease in the first place. But let’s focus on the second part of what is mentioned above which is early detection.
Let’s look at the two most common cancers: breast and prostate. There are over 300,000 cases of breast cancer diagnosed every year in the United States causing 42,000 deaths. The five-year survival rate for any cancer shows a remarkable difference based on stage of disease. Overall, that rate for breast cancer is 90%. If a woman is detected at stage one where the cancer is isolated to the breast in a very confined area, her five year survival rate is 99%. If that cancer is detected at stage 4 where there is evidence of spread to a distant site the survival rate drops to 29% as demonstrated in the chart:
*Localized stage only includes invasive cancer. It does not include ductal carcinoma in situ (DCIS).
Now we look at prostate cancer. There are 275,000 men diagnosed per year causing 35,000 deaths per year. If prostate cancer is diagnosed at stage one the five-year survival rate is close to 100%. If that same disease is diagnosed at stage 4 then it drops to 30%:
These numbers are based on men diagnosed with prostate cancer between 2010 and 2016.
The same holds true of all other cancers. Early detection through established recommendations like mammograms, digital rectal exams for prostate, colonoscopies for colon cancer have a profound effect on long-term survival not to mention reductions in pain and suffering caused by advanced diagnosed cancers.
There is currently a flurry of activity in the ‘liquid biopsy’ space. The concept is that abnormal cells release markers in the bloodstream which can be measured. Based on the level of some of these markers we can detect cancer prior to it even showing up on a standard screening test. Companies like Grail have developed technologies to detect early abnormalities.
It remains to be seen how comprehensive and cost effective these tests will be but early results show them to be highly specific which means if you have a positive test you likely have a malignancy somewhere in your body.
The field of medical oncology has progressed quantum leaps from its early years with sophisticated approaches using tumor markers and targeted genetics-based therapies. Unfortunately, in general the three main methods of treatment have not significantly changed; surgery, chemotherapy and radiation treatment. These therapies have been described historically, and insensitively, as slash, poison and burn. While current treatment modalities have saved and extended countless lives the real success is to prevent these diseases from ever occurring in the first place.
Through the combination of primary prevention and early detection we can avoid hundreds of thousands of lost lives every year in the US alone and with it the associated suffering and grief it causes.