WHY WE NEED TO RETHINK THE CANCER EPIDEMIC

A sustainable society wouldn’t see cancer rates continuing to rise.

Statistics Canada reports that in 2008 cancer was the leading cause of death, ahead of heart disease and stroke combined, which used to be the number one killer. 30% of all deaths in Canada were from cancer, 21% from heart disease and 6% from stroke. A trend of ever-increasing deaths from cancer began decades ago. In 2008, for the first time, cancer was the leading cause of death in all provinces and territories. It was the leading cause for Canadians aged 35-84 and accounted for one-half of all deaths among Canadians 55-64.

In 2011, according to the Canadian Cancer Society, there will be 178,000 new cases of cancer, excluding 74,000 non-melanoma skin cancers. 75,000 Canadians will die of cancer, half from lung, colorectal, prostate or breast cancers. Causality is complex because cancer comes in 200 forms. Cervical cancer involves a virus, while lung cancer involves smoking addiction and also results from radon gas from the uranium industry. Diet is known to be a factor in some cancers; the rising diabetes rate is a precursor for increasing cancers. As more of us live longer our risk of dying from cancer may also increase.

WHY NOT PREVENTION?

We already know enough to conclude that our approach to cancer needs changing. Presently we invest far more resources trying to find cures than preventing cancer in the first place, yet over one-quarter of all cancers result from smoking which is preventable. The approach to prevention matters. As long as we simply held smokers personally responsible for their affliction and counted on reasoning and moral pressure on them to stop, things continued on much the same course. When society put limits on the tobacco industry and smokers, whereby smoking wasn’t accepted as an inherent right and the public health and cost consequences were taken into account, the rate of smoking began to fall. This has still to affect women smokers.

There are some limits to this “social control” approach. You can’t hold people responsible for contacting a cancerous virus, or for breathing, drinking or eating carcinogens put into the environment by industrial practices. Yet these too require preventative public policy. We have to become much more creative and more adamant about this.

ENVIRONMENTAL TOXINS

We lack systematic monitoring of environmentally-induced cancers. The extent of cancer that comes from environmental toxins remains debatable but many authorities, like the recent U.S. President’s Cancer Panel, suggest we “grossly underestimate” this. Several things stand in the way of improved monitoring, in particular, industry’s lack of transparency and accountability. The biomedical model which assumes cancer comes from biological-genetic malfunctions also biases the healthcare system to look for a cure rather than to focus more on prevention.

Basic bio-medical research has nevertheless helped us better understand and treat cancer. And while the incidence of cancer continues to grow, so too does the effectiveness of some cancer treatments which has increased survival rates. Cancer mortality rates started to fall from the 1990s, though we are still behind many other developed countries in this regards. But the human suffering from the increasing incidence of cancer continues to spread. And spending more and more money on treating more and more cancer is ultimately counterproductive and will contribute to bankrupting our healthcare system.

PROFITS IN CANCER

There are also huge profits to be made from expensive cancer treatment and cancer screening programs.  Lobbying by the medico-pharmaceutical industry plays a role in keeping us fixated on treatment rather than pursuing prevention. If we spent as much on prevention as we presently spend on cancer diagnosis such as nuclear medicine we’d be getting on the right track. People with cancer of course should have access to the best and safest medical procedures, but common overuse of diagnostic methods can increase the public’s radiation exposure and even increase the probability of some cancers.

The medico-pharmaceutical lobby also plays on the public perception of risk, which ensures that cancer budgets continue to be weighted to screening and treatment rather than prevention. Basic research questions whether some screening programs even enhance early cancer diagnosis or extend life-span. It’s debatable whether there’s any public health advantage to extending breast and prostate cancer programs to all patients, but it is hard to counteract public pressure for this. Vested interests are always willing to lobby political funders on behalf of patients looking for any reassurance to reduce their fear of cancer. Evidence, not fear, has to be the basis of sound cancer policy.

BALANCED APPROACH

It’s simply silly to ignore the role of environmental degradation in cancer. Rising skin cancer rates relate to increased exposure from UV rays. The thinning of the ozone layer from industrial and consumer pollutants plays a major role in this. Of course a rational approach involves both treatment and prevention; we don’t want those who get skin cancer to go untreated. But we also know that reducing sun-tanning whether on the beach or in tanning centres will reduce one’s risk. Banning the chemical pollutants responsible for thinning the ozone is required to reverse this situation so that risks don’t worsen for future generations. Prevention is vital to create a sustainable society.

This both-and approach clearly applies to smoking, but it also applies to cancers resulting from today’s energy systems. The benzene that goes into tailings ponds at Alberta’s tar sands is a carcinogen, as are various radio-nuclides that are deposited with uranium mine tailings in northern Saskatchewan. We also know diet can play a role in encouraging some cancers. It is counterproductive to continue to allow industrial waste and food industry practices that are cancer-causing to continue to spread. Investing in public health and environmental policies which affirm preventative practices will serve to reduce cancer rates before they require expensive screening and treatment programs.

EVIDENCE-BASED

What would an evidence-based approach to cancer look like? First we’d stop blaming people for their cancers. We’d use public policy, as we have with smoking and must now with diabetes, to reduce behavior that increases the risks of cancer. But we must start to thoroughly monitor environmental toxins so that our knowledge about their role in rising cancer rates becomes more firmly based. And known carcinogens simply must be banned from getting into our air, water and food. Finally we have to put strong boundaries on the medico-pharmaceutical industry lobby that plays on public fears so that questionable but profitable cancer programs keep going. We can’t allow limited funds to be tied up in reacting to the cancer epidemic; we need to get out in front of it, and develop effective preventative measures.

This is easier said than done, but we need to know where we want to go to ever be able to get there. Bringing cancer prevention onto at least an equal footing with cancer treatment would be a big step forward. We must get some balance into the “war on cancer” if we are going to make real headway towards sustainability.

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