Asleep at the Wheel of the War on Cancer By Samuel S. Epstein, MD

Asleep at the Wheel of the War on Cancer By Samuel S. Epstein, MD

Last year, President Obama boldly pledged to reform the national health care system. Central to this reform is containing health care costs which are soaring at about 6% each year. Clearly, this is not possible without a plan to prevent us from getting cancer in the first place.

The cancer epidemic strikes one in three of us and takes the life of one in four. This year, 1.5 million of us will be diagnosed with cancer, of whom, 560,000 people will die. After four decades of losing the cancer war, which President Nixon declared in December 1971, we are taking minimal, if any, action to protect us from this menace.

While research on cancer prevention and treatment of cancer is predominantly the responsibility of the National Cancer Institute (NCI), other federal agencies, FDA, OSHA, EPA, and CPSC are also involved. Unfortunately, such action is minimal and uncoordinated.

Cancer is not only one of the most costly and sometimes deadly, it is also one of the most preventable. The connection between losing the cancer war and the need to control costs through prevention should be clear.

Based on recent NIH estimates, the total annual costs of cancer are $219 billion a year. The annual costs of diagnosis and treatment are $89 billion; those of premature death are about $112 billion; and those costs of lost productivity are estimated at $18 billion. The human costs are surely of far greater magnitude.

Smoking remains the single largest cause of cancer, particularly lung cancer. While lung cancer incidence rates in men have declined by 20% over the past three decades, rates in women increased by 111%. As importantly, non-smoking cancers — due to known chemical and physical carcinogens — have increased substantially since 1975. Some of the more startling realities in the failure to prevent cancer are illustrated by their soaring rates of increase since 1975. These include:

• Malignant melanoma of the skin in adults is increasing by 168% due to the use of sunscreens in childhood that fail to block long wave ultraviolet light;
• Thyroid cancer is increasing by 124% due in large part to ionizing radiation;
• Non-Hodgkin’s lymphoma is increasing 76% due mostly to phenoxy herbicides and phenylenediamine hair dyes;
• Testicular cancer is increasing by 49% due to pesticides; hormonal ingredients in cosmetics and personal care products; and estrogen residues in meat;
• Childhood leukemia is increasing by 55% due to ionizing radiation; domestic pesticides; nitrite preservatives in meats, particularly hot dogs; and parental exposures to occupational carcinogens;
• Ovary cancer (mortality) for women over the age of 65 has increased by 47% in African American women and 13% in Caucasian women due to genital use of talc powder;
• Breast cancer is increasing 17% due to a wide range of factors. These include: birth control pills; estrogen replacement therapy; toxic hormonal ingredients in cosmetics and personal care products; diagnostic radiation; and routine premenopausal mammography, with a cumulative breast dose exposure of up to about five rads over ten years.

A wide range of evidence has related a wide range of cancers to environmental exposures to carcinogens, including formaldehyde, chlorinated organic pesticides, and organic solvents. The increasing incidence of lung cancers has also been related to preventable occupational exposures to asbestos, silica, chromium VI, formaldehyde, methylene chloride, benzene, and ethylene oxide.

The NCI is the primary federal agency ostensibly devoted exclusively to fighting cancer. Paradoxically, the escalating incidence of cancer over the last thirty years parallels its sharply escalating annual budget – from $690 million in 1975 to $5.2 billion this year. Of this a mere $131 million — or 2.5%% — is allocated to NCI’s mission on Prevention and Early Detection.

However, in spite of well-documented evidence relating the escalating incidence of cancer to a wide range of avoidable carcinogenic exposures, the NCI remains “asleep at the wheel,” and has stubbornly refused to devote resources let alone attention to prevention.

The NCI has ignored proddings from Congress and independent scientific experts to develop a comprehensive registry of carcinogens. Worse still, the NCI claims that most cancers are due to unhealthy behavior, such as smoking, poor nutrition, inactivity, obesity, and overexposure to sunlight, and that a mere 6% are attributable to environmental and occupational exposures. These claims are despite overwhelming evidence to the contrary.

Furthermore, the NCI has touted the imminent success of new cancer treatments–promises that have seldom been borne out. For instance, in 2004, Nobel Laureate Leland Hartwell, President of the Fred Hutchinson Cancer Control Center, warned that Congress and the public are paying NCI $4.7 billion a year, most of which is spent on “promoting ineffective drugs” for terminal disease.

Congress now has an epochal opportunity to reform our health care system and prevent cancer from occurring in the first place. By taking some simple steps to achieve this, Congress should enact specific legislative reforms to the 1971 National Cancer Act:

• Declare that it is the national policy to reduce carcinogenic exposures to confirmed or suspected carcinogens by at least half during the next decade.
• Allocate at least 40% of the NCI budget to explicit prevention-related programs for FY 2011, and 50% by FY 2014.
• Mandate the annual publication of a comprehensive register of carcinogens. This will provide federal, state, and local governments, as well as the public, with comprehensive information on carcinogens in the workplace, environment, and consumer products so that necessary preventive action can be promptly undertaken.
• Create a Deputy Director for Cancer Prevention of the NCI who, together with the administrators of EPA, OSHA, CPSC, FDA, and other relevant agencies, shall report to Congress annually on steps needed during the next decade, under existing regulatory authority, to reduce the prevalence of future preventable cancers.
• The NCI shall meet regularly with the administrators of EPA, OSHA, CPSC, and FDA to identify opportunities to reduce exposures to carcinogens in the environment, the workplace, pharmaceuticals, and consumer products — food, household products, and cosmetics and personal care products.
• These steps alone will not win the war against cancer, but they will be critical in redirecting a failing war on cancer that can best be described as one of the most notorious public health failures of the 20th century. Cancer prevention is a critical public policy area

From Asleep at the Wheel of the War on Cancer By Samuel S. Epstein, MD

in which reform is long overdue.