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Walking through malls, airports and grocery stores in this country, I am often struck by the massive proliferation of the pink ribbon and the impressive power of the breast cancer advocacy movement to garner attention and get things done. When one considers the prevalence of various tumors by age (Figure 1), it becomes evident why a disease that represents less than 10 percent of all cancer mortality has become so top-of-mind to the public.
More than 10 million citizens in the United States are “cancer survivors” — an interesting term that has become a permanent part of our lexicon, even though many of these people will eventually die of this disease and almost all live with concerns and fears about cancer recurrence.
What is particularly striking about these statistics is how the age of incidence and the “lethality” of a tumor type create a formula for survivorship. At one end of the spectrum, we have breast and prostate cancer, with long natural histories — even in many patients destined to succumb to progressive disease — and relatively high “cure” rates. On the other hand, we have lung and pancreatic cancer, where most patients are dead in a couple of years and the pool of survivors is minuscule.
This has led to an unequal balance, with an eye-opening 4.2 million breast
and prostate cancer survivors, yet even these two subpopulations can’t be
grouped together because there are far more younger survivors of breast cancer
who historically have proven to be ready, willing and able to push for change.
The constant threat of recurrence and progression means that most cancer
survivors keep an anxious eye on developments in cancer research, despite the
recent NCI Cancer Bulletin proudly reporting “a 2.1-percent decrease in cancer
mortality rates between 2002 and 2004, an approximate doubling of the 1.1-percent decline seen each year from 1993 to 2002.
* See Link
These anxious survivors would be dismayed to learn of a recent poll we conducted with the 11 clinical investigators who participated in our breast cancer think tank last summer, suggesting that most experts don’t expect a meaningful drop in breast cancer mortality in the next 15 years (Figure 2).
This is not a subject that is frequently discussed. Physicians don’t like to be reminded of the shortcomings of their treatment tools, particularly when they spend the day trying to reassure desperate patients, and investigators don’t want to constantly revisit the tribulations of obtaining adequate support for cancer research.
As a result, we often accept
the outrageous and unacceptable,
such as the fact that two
years after Rowan Chlebowski’s
first presentation of the
WINS trial data (Chlebowski
2005) demonstrating a 24
percent reduction in cancer
recurrence in patients
randomly assigned to instruction
to lower dietary fat, a
follow-up study is not being
planned, and Rowan still
doesn’t even have the funds
needed to study the sera of
the WINS patients to help
figure out what’s going on.
Perhaps even more distressing than this somewhat bleak perspective on breast cancer — our research vanguard — is the lack of progress in other tumor types (Figure 3) that threaten breast cancer survivors and the rest of us.
So maybe it’s time to replace the pink ribbon with a multicolored version that represents the complex spectrum of related neoplasms that currently comprise the profound public health catastrophe that is cancer today.
Perhaps if these 10 million strong and their loved ones unite together regardless of primary cancer, we would see the necessary resources allocated to find quicker solutions to this very grave problem.
— Neil Love, MD
DrNeilLove@ResearchToPractice.com
November 30, 2007
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EDITOR'S NOTE
Survivors
Neil Love, MD
- Select publications
INTERVIEWS
Ian E Smith, MD
- Select publications
Charles L Vogel, MD
- Select publications
Sandra M Swain, MD
- Select publications
Paul E Goss, MD, PhD
- Select publications
Hannah M Linden, MD
- Select publications
Breast Cancer Update:
A CME Audio Series and Activity
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