The war on cancer

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In 1971 (a full 39 years ago) President Nixon declared war on cancer.  Actually, he never used those terms, but others did when the new legislation came into force that set up the national cancer institute and set aside tons of cash to do cancer related research.  In 2004, the estimated total amount of research dollars that went into cancer was about 14 .5 billion dollars.  Although that number varies from year to year it has most likely risen since then.  This number is derived from both public and private funding including that from pharmaceutical companies.  That is a lot of mulah.  What has the cancer community done in that time?  That is the real question.

Well, it has NOT won the war on cancer.  However, although there are quite a number of very negative commentaries out there, all is certainly not lost.  The nay-sayers say that although other areas of killers such as heart disease have drastically gone down, cancer is only increasing year on year.  They also say things like cancer is the biggest killer for those under 75 and that heart disease, accidents and strokes combined still kill less than cancer does for those between the ages of 45-64 (at least in 2004).  They point to the fact that the percentage of people dying in 2004 of cancer was the same as that back in 1970 and even back in 1950.  Many statements like that do seem to indicate that we are indeed losing the war on cancer.

I beg to differ and I don’t think that these numbers tell the complete story.  But, I do agree with some conclusions being made about how cancer (and other actually) research is done and how it is funded in the US.  Many think the system is broken and I happen to agree with them.  Let’s take a look at this closer before I talk about why we may no be necessarily losing the war on cancer. 

Cancer research is funded by national cancer agencies and other agencies when reproducible results are almost guaranteed.  That means that grants have a good chance of succeeding if the researcher is asking something that can be reproduced or copied many times.  For example, using mice to study human cancer allows for very good reproduction of the anti-cancer agent in question.  The cancer agencies and the FDA who approves the drugs that come out of these studies are discouraging risks.  They encourage authors of the grants to focus on very tiny parts of the puzzle where ver defined results can be reproduced and published.  This HUGE push for publication drives the entire process.  The leaps in faith or risky but potentially rewarding research is often not fundable.  ALthough, there is some good in this; namely appropriate testing of the scientific hypothesis, etc…this is not good for cancer research if we are to rapidly produce drugs that will work well NOW. 

Furthermore, the model systems we are using are insufficient.  The mouse, rat and cell systems that are used are fantastic for some basic scientific questions but fairly lousy in addressing the real need:  a curative agent to help humans.  Millions upon millions of mice have been successfully treated of the cancer that researchers gave them in the lab.  What about the cancers that we did not give humans in the real world.  Have we cured or successfully treated them to the same degree.  The answer is a resounding NO.

In this blog I will not address how to fix the problem as I only have a few answers and many questions.  But, in short the FDA needs to be reworked, the grant agencies need to fund science that takes bigger risks and rewards people NOT who publish but who have real results with people.  The pharma companies need to focus on creating better models instead of tumor shrinkage in mice which almost NEVER equal successful treatment in humans.   

Let me wrap up by being a bit less pessimistic and perhaps more realistic.  Yes we have spent billions and billions of dollars on cancer and no we have not been able to cure all or even most people with cancer.  Yes, people are dying of cancer more often; in fact, in the US one out of every 2 men and one out of every 3 women are now dying of cancer.  But, I don’t necessarily think we are losing the game and I am not even sure if its fair to say that this game is something that we need to win.  Let me explain.  1) Children’s cancer (leukemias) are now being treated very well with excellent progress in the last 30 years.  2) The research that we have done over the last 30 years will not pay off immediately, statistics about efficacy (how well the drugs do) will take years to figure out and the benefits are probably ten years away still.  3) The amount of information that we have learned by delving into cancer in the last 30 years is astounding, even though most publications deal with only the tiniest piece of the puzzle.  This amount of information has not yielded huge numbers of life saving blockbuster drugs yet, but they lay the foundation for other researchers to do so.

Finally, here is something controversial; are we supposed to win the war on cancer?  Look at the issue of HIV.  We have spent billions and billions of dollars and trying to solve ONE disease (not like cancer which is made up of more than 100 different diseases) and we are nowhere near a cure.  People are reliant on drugs for the rest of their lives just to live and many others die from a single virus!  So, what makes us think that just spending money and putting people on a task such as cancer, will automatically turn us into God, Buddah, Allah or whomever.  Whose war are we winning?  Are we supposed to live forever?  Are we ever going to achieve cancer cures in a 95-year-old patient?  In fact, part of understanding what cancer is…is understanding what normal is…for cancer is the result of abnormal growth of something that was normal first.  Do non scientist even realize that despite knowing all or most of the human genes we still don’t understand all of the normal working of the cell.  There are so many networks, pathways, and so on that we are still learning about every day.  How can we win the war on cancer if we have not won the war on normal physiology? 

So, I don’t mean to end this post on a negative note.  I think we have come a long way. Despite some of the inherent problems we have with the system, we have made progress.  Some of the progress that we have made will be seen in the near future.  People who are diagnosed with cancer will live longer, either because it is caught earlier or because it is treated better. 

Thanks and for more information please see….Cancer Made Simple

Statistics continued

Mark Twain photo portrait.

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Merry Christmas and Happy New Year!

Many people feel just as Mark Twain did when he famously said, “lies, damned lies, and statistics‘.  This general feeling, that statistics can often tell any story the storyteller wants to tell…even a lie, is exacerbated when dealing with cancer.  The doctor who is seemingly being honest when he tells a patient that he/she has five months to live is perhaps falling into this category.  Unfortunately, statistics frequently allow the user to distance him/herself away from feelings and caring if not used with caution.  On the other hand, care and feelings often do not evoke any statistical methodology and are thus often too unscientific.  Let’s look at a cancer statistic and see the danger of how cancers can be reported and affect people perhaps negatively.  Mesothelioma, if you look at the literature and clinical guidelines/statements is uniformly incurable and has a median mortality of eight months after diagnosis.  Now that is scary…that seems hopeless and like most people you and I would be pretty depressed seeing or hearing that.  But, wait…let’s see what the stats really mean.

It is still unclear why, but it is quite apparent from hundreds if not thousands of anecdotal if not scientifically valid studies that attitude matters and it matters in a big way when dealing with cancer.  It is still not well-studied but this is probably related to the immune nervous system (read: brain) access.  Negative statistical information (even if it’s not negative but it is PERCEIVED to be negative by the recipient) is absolutely harmful for people (like many of us) who are unsure of ourselves, or our conditions, or whom are nervous and scared and certainly not confident.  It only helps to reinforce our feeling of helplessness, a less than strong purpose (or will) of living and so forth. 

So does a median mortality of eight months really mean I will likely di of my cancer in eight months or not.  Actually, this statistical information for this type of cancer that is relayed in clinical guidelines and in the literature (in reviews or after years of experience treating this type of cancer) is not really the case at all and thank goodness too as we have just stated that giving up is a sure way of hastening our demise.  In fact, giving up means sometimes taking our doctors for their words without thinking for ourselves or giving us options or hopes.  Due to our natural tendencies to see things as black and white and having sharp edges and distinct cut offs, we often miss the point when we look at statistical statements.  All statistics no matter how precise the numbers are depend on variaton for their derivation and variation is the spice of life…that is how we evolved to how we are.  When confronted with something like a median, it is often useful to not lump yourself in that median and conclude that you are doomed but to think about it this way….if median is half then there is the good half (those that live longer than 8 months) and the bad half (those that dont) and ask yourself what is it that makes me in the better half.  ANother way of saying it is…why can’t and shouldn’t I be in the half that survives. 

In fact, there are often really valid reasons that there are ‘good’ and ‘not good’ halves.  In this cancer situation, being quite old or having this cancer caught at a later stage makes you more likely to be in the bad half, while being young, fit, healthy, and no other major medical complications helps to put you in the good category.  So, ALWAYS ask yourself or your doctor….what are the factors that greatly contribute to bad out comes of the disease/cancer that you have.  Don’t assume that you will follow what the median follows. 

Here is another important point about this statistical information.  The distribution might not be even when you are talking about the median.  Median implies right down the middle.  On one side of the middle is death before 8 months and the other side is death after 8 months.  But, on the side of death before 8 months it might very well be likely that the distribution is even…most people die at between 7-8 months (just an example). However, on the other side of the median, those who survive longer, the distribution may be very skewed….people then to live 20 years more than the 8 months.  Wow, now isn’t that different from what you might have originally have thought…now instead of resigning yourself to 8 months left, you might actually want to consider that you have a good 20 years or so more to go.  So in general for a median of such a small number of months the curve on the left side (less than 8 months must be very sharp…between 0-8 months, but the curve of the right side can and is frequently very large….even the rest of someones life. 

And here is one more piece of good news; the median mortality of 8 months for mesothelioma is only accurate for treatments that have been around prior to when you are reading them.  So what this means is that if you are taking a new drug or an investigation drug, it might shift the median to many many years.  That data wont be out for many years to come, but it certainly gives hope…novel therapies are not designed to shorten life…only extend them. 

Well there you go!  This is a case where positive attitudes combined with a little bit of knowledge  (either yours or someone else’s) that can change you life.  Please please and please don’t just listen to what the doctor says…think about what he/she says and think about what they may not know.  Many doctors are not going to think about the distribution of the numbers or your exact chance of survival.  They are thinking about the community and the survival of all their patients. 

Thank you for reading and again do let me know if you have any questions about this or any other cancer related topic.  Please do visit my website at www.cancermadesimple.com

This information was partially derived from a wonderful article written by Dr. Steven Jay Gould and the original article can be found that this website….http://cancerguide.org/median_not_msg.html

Thanks Dr C.

US cancer stats part 2

Inherited breast cancer es

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Statistics for cancer such as incidence, mortality, 5 year survival rates and so forth help to set national standards and anti standard programs.  They are important in any country in order to plan for health care funding and resources for years to come.  As long as cancer kills people in the numbers that it does now, funding for cancer research and clinical intervention will always be given top (or nearly top priority).  Thats why cancer statistics are so important.  Many foundations and cancer grant agencies use these numbers to justify their fundraising and administrative actions. 

Let’s examine in more detail US Cancer statistics some more.  Again, 1.52 million new cases are estimated to be detection in all of 2010 with about 596,000 deaths in the same year.  Simply dividing those numbers give us an estimate of the death rate in 2010 which is about 39%.  This is just a rough estimate and just gives us a general idea of new cases and those dying of the same disease in 2010.  60% are living and roughly 40 are dying due to cancer if you just look at incidence rates.  It is important to note here that there are greater than 2 million unreported types of skin cancers that are not included in these numbers…thus the incidence is a lot higher.  However, many of these basal cell and squamous cell skin cancers are treated successfully and never make it on the national registries.

Close to one out of ever four deaths in the USA are due to cancer now.  Even though heart disease is still the biggest killer overall, for those under 75 years of age, cancer is the biggest cause of death.  For men, three cancers are by far the most common and they are  prostate, lung/bronchus, and colorectal and they account for slightly more than 50% of all newly diagnosed cancers in 2010. For women, the top three cancers are breast, lung/bronchus, and colorectal.  In both men and women prostate and breast cancer account for nearly a third of all the new cases in 2010.  The good news for men is that close to 100% of all the prostate cancers are diagnose either early enough or those that are regional (in one spot on the testes) and most are treated successfully (here that means 5 year survival rates are close to 100%).  I wont go into detail about state to state differences except to say that in states where the incidence of smoking is higher than other states….you wont be surprised to know that the lung cancer rates are higher.  The same goes for breast cancer…the states that have the best breast cancer screening programs tend to see lower rates of mortality due to breast cancer there.

Another interesting statistic gleaned from 2010 figures is that all four of the top cancer killers in men and women have all shown a decline in incidence since the previous five to ten-year figures except for one cancer.  Strangely enough, lung cancer is actually increasing in incidence in women and not men (but at a much slower rate than before).  The reason for this is that female smoking patterns are about 20 years delayed in women.  Historically, it took them longer to get addicted and for it to be socially acceptable and thus death rates due to lung cancer are going to be delayed as well.

Ok well…let’s take a break here and pick up again in a few days.

Once again let me know if you have any specific questions and please do visit my cancer made simple website for more info.

‘Thanks..Dr C

Cancer Stats US 2010

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Let’s continue with the theme of Cancer Stats.  This topic is full of information and can go on forever, but I just want to point out a few major stats that are important to note.

The US has very comprehensive and transparent cancer registries and national reporting systems, so generally the numbers in the US in terms of cancer stats can be trusted.  US is a country of Caucasians (white or hispanic) and blacks (African-American) so it is not representative of all areas of the world especially Asia.  However, these stats do reflect modern cancer rates in today’s world and are to be taken very seriously.

The top ten cancers in the United states for both women and men is included in this table:

Cancer Statistics, 2010

  1. Ahmedin Jemal DVM, PhD Strategic Director1,*,
  2. Rebecca Siegel MPH Manager2,
  3. Jiaquan Xu MD Epidemiologist3,
  4. Elizabeth Ward PhD Vice President4;  Article first published online: 7 JUL 2010; DOI: 10.3322/caac.20073; Copyright © 2010 American Cancer Society, Inc.

Please see how these numbers differ from the world stats from the ast blog entry.  But, let’s see some important issues here: the biggest estimated killer this year in men still Lung cancer as expected.  However, do note that the most common cancer for new cases in men is not lung it is prostate.  This tells you two thing; one, lung cancer kills much worse than does prostate cancer and that we can treat prostate cancer a lot better than we can treat lung cancer.  This is indeed true.  But hidden behind this is that there is an active program in the US and other parts of the world to screen for prostate cancer and this does help to detect it earlier and thus making it easier to treat.  Many (but not all) lung cancer are due to smoking and other environmental damages.  Thus, in the future if anti smoking campaigns start working or if tobacco based products are designed to be safer, then we can get these number (lung cancer deaths) to go much lower. 

In women, the same trend can also be seen.  The top new cancer in women in 2010 is breast cancer at almost 30% of total cancers.  However, the biggest killer of women is lung/bronchial cancers.  Thus, detection is playing a huge part in detecting breast cancer earlier as to favor a better treatment.  IT also underscores that smoking is not a male problem, it is both a male and female problem.  Lung cancer is something that we can slow down but it is a lifestyle issue and a marketing issue that we might be better able to control in the near future.  Breast cancer is still a large killer of women and even though much progress has been made, better treatment are needed especially for the resistant forms of breast cancer than some women get.

 The total number of estimated new cancers in the US in 2010 is about 1.52 million.  About .57 million deaths are estimated to occur due to cancer this year.  This is roughly 37% death rate if we simply look at 2010 figures…this is not a fair comparison as the deaths are associated with many people who had cancers detected prior to 2010, but this gives us a good overall figure to estimate how we are doing in the year 2010 compared to the year 2009 (sorry I don’t have that ratio now, but I will find it and get it soon).  If this number goes down from year to year, than we can say that we are loosing fewer and fewer people from cancer in general.  Yes, in general especially amongst men the death rate associated with cancer has gone down nearly 20 % since 1990. In women, that rate is about 12%.  Thus, we are not doing as well with women’s cancers overall as we are with men’s.  Overall, 1 in 4 deaths in the US are due to cancer.  This is very similar to much of the developed world.  As we are living longer and better at detecting cancer and better at treating non cancer, these numbers are likely to go up.  The question is, will we be able to treat those with cancer better and better to allow these people to live longer and better lives.  I think we will…I am optimistic!

 Thank you Dr C please see Cancer Made Simple for more info.

Cancer Statsitics continued

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I have previously provided some definitions of frequently used cancer terms.  As promised, I will continue with the cancer stats theme and provide some cancer statistics for worldwide incidence and mortality (see previous blog entry for these definitions.

When providing information about the number of deaths associated with cancer overall and even some specific cancers, age must be factored in.  This is because age plays such a large factor in determining risk of death from cancer.  Older folks do have much higher risks associated with dying from cancer than younger folks do.  Another important thing to note is that worldwide statistics are becoming more and more readily available as there are more country and regional cancer registries established and the fact that deaths are almost always classified as to what the cause of death was, so deaths related to cancer are available in most countries, regions and other sources.  However, not all information is available in all places and some countries are known to under report their cancer deaths by a certain amount.  Information I will provide come from a source (referenced below) that was comprehensive in 1999. 

Let’s first take a quick glimpse into population based relative survival rates for various cancer for the entire regions of US, China, India and Europe.  I will just give some highs and lows and not all of the data.  For example, both developing and Westernized countries have low 5 year survival data for pancreatic cancer at between 4-5%.  This means that this cancer really does kill and no areas are overall immune from this.  Lung cancer is also a big killer with very low survival rates in all countries (from 14-8%).  However, unlike pancreatic cancer if you live in the west your chances for survival are on average 14% but if you are from developing nations it is more like 8%.  Another cancer that is difficult to treat and has high mortality over five years in that of stomach cancer.  Here if you live in India your overall 5 year survival is about 7% but can reach as high as 21% if you live in the US. A very big difference exists in leukemia (there are lumped together here, but remember there are quite a few different ones).  In the US your overall survival rate is 42%, but it is as low as 1/4th of that if you live in China where your 5 year survival is on average 10%.  So you see, it really depends on where you live. On the other hand, the cancer that presents with the highest survival rates are that of testicular cancer (guys are too lucky) where the survival rates are as high as 95% in the US and as low as 50 in developing countries, and roughly 74% in China.  Other cancers that are in the 80-90% region include breast cancer (overall), melanoma, Hodgkin’s lymphoma and certain types of uterine cancer.  Again, the numbers go down quite dramatically for these cancers in developing countries as well as India and China.  An important thing to note is that in many blood cancer where survival rates are increased very high due to the availability of transplants, developing countries, India, and China do NOT have such high rates due to limited access to these types of therapies which are very expensive, etc.  For the entire world, the worst cancer is pancreatic cancer at a total survival rate of just 1% and the best cancer belongs to testicular cancer at 78%, and then breast cancer at around 61%.  As you can see it really maters allot where one resides and the standard of care present or absent there.

Now let’s look at global estimates of all cancers and their overall mortality rates.  Approximately 8.1 million cancer were newly detected in 1991 and that compares to about 37% more than 1975 when the last comprehensive count was done.  That is about 2.1% a year and faster than the rate of replacement over that period.  That same year about 5.2 million deaths occurred and half of these came from the developed world.  So, although the 5 year survival rates are generally worse in non developed countries the overall mortality is not that different.  Looking at overall world statistics the total for women and men is about 3.8 and 4.2 million incidence rates.  Thus, men are still in the lead.  Looking at incidence of individual cancers, men still die mostly of lung cancer (16% of all cancers) and women of breast (21%) and the second most common cancer for men is stomach at @11% and women is colon and rectum at @10%.  The biggest worldwide incidence of cancer for both men and women is still lung followed by stomach.  This is interesting due to the fact that smoking is a known VERY serious risk factor that can be eliminated and that food and diets are very nicely linked to increased risks of stomach cancer. 

Ok well there are lots more that I can say, but why don’t we take a break. Again do let me know if you have any questions of comments about this or any other cancer issue.  I am more than happy to provide more feedback and comments if needed.  Please do come and visit me at my website at Cancer Made Simple!

For more information about the stats found on this blog please see…. the 1999 publication by D Max Parkin et al. C A C a n c e r J C l i n 1 9 9 9 ; 4 9 : 3 3 – 6 4

Global Cancer Statistic, 1999

Thank you Dr. C

Cancer statistics terms

Mortality Rates vs. Chosen Profession

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This blog entry is devoted to helping you understand some very important terms that will help you look at and understand cancer information such as incidence, deaths, rates, etc.  I hope you find this useful and do hope you ask me any questions or make any comments you might have!  Why do I think this is important?  First of all, statistics are thrown around all the time by people.  Depending on the numbers that one uses the information can be very misleading.  Frequently, I have noticed people quote cancer statistics incorrectly and make false assumptions and declarations.  Secondly, people can easily use statistics to falsely make something less or more serious than it is to try to get you to buy their product or to see things their way.  Last but not least, is that understanding a little bit about cancer statistics makes you understand that these numbers are usually rough estimates and not 100% facts. 

Incidence vs. prevalence.  Incidence is the number of NEW cases of cancer (or anything else) that occurs within a specified period of time (usually a year).  Sometimes you might see the incidence as a rate like 1 per 100,000 in 2009.  Or you might see incidence displayed as an actual number per year.  The rate helps people to see the average risk that they may have/had during that year.  While the absolute number helps people to see the volume of people who had cancer during that year.  Either way, these numbers can be helpful in determining the new cases of cancer diagnosed in that particular year.  So you might compare one year to another to see if the incidence of cancer is going up or going down.  Prevalance on the other hand is   the actual n umber of people having cancer (or any disease) at a particular point in time.  It is the total accumulation of known person with that disease who are alive.  What this means is that those who have been cured of the disease or who have dies of the disease are NOT included in these numbers but the ones who have the disease and the new ones who are newly diagnosed are included.  The cure rate is usually defined at survival after five years (for better or for worse) and thus those surviving after treatment of five years would not be included in the prevalence figures.  However, total numbers of patients with cancer is VERY hard to derive as some don’t seek treatment, etc. 

Mortality:  This term refers to the number of deaths occurring due to cancer (or a certain disease) within a specified time frame.  Health care professionals usually like to report the mortality rate which is the number of deaths per 100,000 people per year.  This is useful as people generally like to see if cancer as a whole or certain cancers are killing more or less people from one year to another.  Winning the war on cancer may not actually mean eliminating cancer (which is probably not very realistic) but reducing the mortality rate associated with cancer as a whole.  Fatality is another related term which indicated the proportion of people who die of cancer and is pretty much absolute…you can’t get any lower than death.  This is useful when comparing one cancer to another or cancer in general to let’s say cardiovascular associated deaths (e.g. heart attacks).  martality should be used as an outocme measure and not as an indicator of the average risk of acquiring the diesase.  Note:  mortality is most helpful when looking at a population of peoples while fatality is more useful when assesing individual risk. 

Lost life year:  Another more complex statistics that is often used is the number of years of quality life that is lost when someone gets cancer.  This assumes that we know the total number of average years a healthy person lives and then comparing that to the total of years a person of cancer lives.  If they get cured than they may be the same but if they die of the diease then the quality of life years goes down unless they die of the disease very late in life.  The later can happen in some cases where treatment is very good.

Ok, well I hope this help a little in terms of assisting you with some terms that are almost always used when looking at cancer statistics.  In the next blog I will actually provide some of the world figures for cancer incidence, etc. 

As usual, I welcome you to visit my web site for more information and I welcome a discussion either here in this blog or on my site. Thank you…….Dr. C

www.cancermadesimple.com