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Cancer prevention: Seize the low-hanging fruit, then work upward

By Susan Dentzer | March 29, 2018

Cancer prevention: Seize the low-hanging fruit, then work upward

Today’s blog comes from Susan Dentzer, president and CEO of the Network for Excellence in Health Innovation and one of the nation’s most respected health and health policy thought leaders and journalists. The Prevent Cancer Foundation® is excited to welcome Ms. Dentzer to moderate the closing keynote panel “Visions for the Future of Cancer Prevention” at the 2018 Dialogue for Action® on Cancer Screening and Prevention.

Cancer prevention is like many other issues in U.S. health care: There is much low-hanging fruit to harvest, but there’s also important bounty to be gained that’s harder to reach. On the panel that I’ll moderate at the 2018 Dialogue for Action® on April 13, we’ll discuss the opportunities and challenges inherent in both approaches to cancer prevention.

One of the biggest weaknesses of the U.S. health care system is that it is precisely that – a system to provide care, and largely “sick care,” rather than an organized system to advance, sustain and improve health. Prevention is under-prioritized; most of the effort and dollars flow to sick care. Nowhere is this fundamental failure more significant than in cancer and cancer prevention. 

The World Health Organization (WHO) estimates that anywhere from 30 percent to 50 percent of cancers are preventable. Although cancer death rates in the United States have been falling—by a total of 26 percent from 1991 to 2015—further dramatic improvements could be made in lowering cancer death rates with two key prevention measures: eradicating or at least sharply lowering tobacco use and eliminating or at least sharply curbing obesity.  

Tobacco use is the largest source of preventable death in the United States; an estimated 40 percent of the cancers diagnosed in the nation—from esophageal to cervical and rectal cancer—may have a link to tobacco use.  From 2009 to 2013, according to the Centers for Disease Control and Prevention (CDC), about 343,000 people in the United States died each year from a cancer related to tobacco use.  

If the nation did nothing other than completely eliminate tobacco use, over time we could probably cut our cancer death rate almost in half. Yet in 2016 about one in seven, or 37.8 million, U.S. adults were still smoking cigarettes, with many others using other forms of tobacco, such as smokeless tobacco. 

Close behind tobacco use as a cause of cancer is America’s rising epidemic of obesity.  More than one-third (36.5 percent) of U.S. adults and nearly a fifth (18.5 percent) of two- to 19-year-olds are obese. The National Cancer Institute (NCI) says there is “consistent evidence” that obesity is associated with a range of cancers, from endometrial, breast, and ovarian cancer to liver and kidney cancer and multiple myeloma. A group of CDC researchers foundthat in 2014, 40 percent of all cancers diagnosed were associated with an unhealthy weight and obesity.

A nation truly serious about health preservation and disease prevention would be pulling out all the stops to drive down smoking and obesity rates by whatever tools it had available. At present the United States is falling far short of what is necessary to address tobacco use and obesity and their contributions to cancer.

So much for the “low-hanging fruit” in cancer prevention. What should the nation do to reach further up the tree, to seize the benefits of other strategies for preventing cancer? The 2016 Cancer Moonshot Blue Ribbon panel reportlaid out a number of possibilities:   

Broader cancer screening and early detection:  As the science of cancer advances, we know more now about which pre-cancers or very early stage cancers can and should be found and removed or treated early. Colorectal cancer screening and early polyp detection is a key example. A 2016 studyfound that the United States had sufficient colonoscopy capacity to screen 80 percent of the eligible population by 2024. What would it take to get to 100 percent?  Will colonoscopies remain the preferred mode of screening, or are there other technologies to be employed that would get us to universal colorectal cancer screening among adults sooner?  

Vaccination against human papillomavirus (HPV):  More than 30,000 cancers are diagnosed each year in the U.S. that are attributed to HPV, including cervical, vulvar, vaginal, oropharyngeal, anal and penile cancers. In 2016, 60 percent of U.S. teens ages 13-17 years received one or more doses of HPV vaccine. Broader efforts to educate parents and teens about the benefits to the vaccine are paramount. 

Hereditary cancer screening: Although relatively few cancers are hereditary, about 50 known hereditary cancer syndromes have been identified to date, ranging from certain breast, ovarian and eye cancers, to gene mutations leading to multiple cancers in the case of Lynch syndrome and Cowden syndrome. As the Blue Ribbon report notes, “hereditary cancer testing in appropriate populations is a cancer prevention strategy that is currently underused.” An estimated one million people in the U.S. have the gene mutation known as Lynch syndrome, which causes hereditary nonpolyposis colorectal cancer, but don’t know it. Up to 400,000 women have hereditary breast and ovarian cancer syndrome that is not associated with the well-known mutations BRCA1 and BRCA2. Screening women with breast and ovarian cancer for these mutations could help identify other family members at risk.

The next ten years

Our Dialogue panel will discuss where cancer prevention is headed within ten years, and as moderator I encourage you to join that discussion. In the dawning age of precision medicine, a better understanding of the body and its inflammatory and immune system responses that factor into pre-malignancies, “provide unprecedented possibilities to transform cancer prevention,” noted a special 2016 report in Cancer Prevention Research.

It’s exciting to think about how many new opportunities lie ahead to prevent cancer, and to treat it effectively, especially at the metastatic stage. But let’s not let the excitement blind us to pursuing the low-hanging fruit that would extend the lives of many millions in this country and around the world.

Register today
Dialogue for Action® on Cancer Screening and Prevention
April 11-13, 2018
Hilton McLean Tysons Corner
McLean, Va.

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