Blog | Wednesday, August 5, 2015

Cancer mortality news, between the lines


A Centers for Disease Control and Prevention report just released indicates that the age-adjusted risk of cancer death is declining for Americans overall, and the trajectory is largely in line with the aspirational objectives of Healthy People 2020. There are several, salient messages in this report, and at least 1 more between its lines.

First, as noted, the principal finding is that cancer mortality rates among those affected by cancer are declining markedly, largely in accord with Healthy People 2020 projections. This is excellent news, and testimony to the conjoined power of early detection and ever improving treatments. To my colleagues in oncology, research and practice: well done, and thank you!

Second, this report reminds that the longer we avoid dying from 1 cause, the longer we live to encounter another. After all, we will all die of something eventually. Mortality from heart disease is declining faster than from cancer, and life expectancy is rising. This means more overall cancer at the population level. This, too, was noted in the article: the risk of dying prematurely from cancer is declining, but the total number of cancer cases is rising as the population grows, and lives longer. This, I suppose, is a wisp of dark cloud encircling the silver lining, but really, just a wisp.

Third, this report reminds of disparities, since mortality reduction is not even among cancers, sexes, regions, and races. Where there are gaps, there is opportunity- and work to be done, often directed at better access to care, and more consistent recourse to early detection.

Finally, there is a key message found only between the lines of this report: reducing cancer mortality and reducing cancer are not the same.

Way back in 1981, Doll and Peto first highlighted the substantial preventability of cancer by lifestyle means. Most authorities remain convinced that 30% to 60% of cancers could be prevented outright by tobacco/toxin avoidance, optimal diet, routine activity, and weight control. The “side effects” of this approach would be the prevention of diabetes, heart disease, obesity, stroke, dementia, etc., in the bargain.

Ever more effective treatment for cancer is very good, and a declining death rate is excellent news. But fewer of us ever needing such treatment in the first place, because we never develop cancer, is, of course much better. The promise of cancer prevention is far from fully kept, and deserves much more attention. The relevant medicine resides not at the cutting edge of biomedical advance, but in our lifestyle patterns, and the priorities of our culture.

David L. Katz, MD, FACP, MPH, FACPM, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care. He is a board certified specialist in both Internal Medicine, and Preventive Medicine/Public Health, and Associate Professor (adjunct) in Public Health Practice at the Yale University School of Medicine. He is the Director and founder (1998) of Yale University's Prevention Research Center; Director and founder of the Integrative Medicine Center at Griffin Hospital (2000) in Derby, Conn.; founder and president of the non-profit Turn the Tide Foundation; and formerly the Director of Medical Studies in Public Health at the Yale School of Medicine for eight years. This post originally appeared on his blog at The Huffington Post.