A Week of Cancer News–Be Cynical!!

The American Cancer Society leads off the week with the good news that cancer deaths are continuing their slow decline. The data from 2006 attributes most of the improvement to smoking cessation and earlier diagnosis (particularly in colon cancer). We can expect to inundated with more cancer news from the ASCO (American Society of Clinical Oncology) starting this weekend–watch out for the hype and overstatements!

“The new rate shows 181 cancer deaths per 100,000 people. That was down from about 184 in 2005.”

“The CDC recently reported death rates fell for:

• Lung and trachea cancers, from 54 deaths per 100,000 in 2005 to 51.5 in 2006.

• Colorectal cancers, from 18 to 17 per 100,000.

• Breast cancer, from 27 to 23.5 per 100,000.”

It’s wonderful that fewer people are dying but it should be noted that the most effective intervention was the cheapest–prevention. By having fewer smokers in our population there were few people with lung and related cancers.

Early diagnosis also is an effective intervention. Much of the improvement in outcomes of such diseases as colon, breast and prostate cancer have nothing to do with outrageously expensive treatments but rather are due to early diagnosis and treatment because of aggressive screening for the disease–yes I know prostate screening is somewhat controversial but deaths from prostate cancer have declined since we started screening in the early 90’s.

Treatment is least effective means of extending life. Yes there are successes, such as leukemia, some lymphomas, and testicular cancer. But the survival improvement from aggressive treatment of most advanced cancers has been stagnant for 30 years. Whether new $100,000/year drugs will change this has yet to be proven–so far the data casts doubt on the cost-efficacy, and utility of such expensive treatments.

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