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Sunday, December 04, 2011

Soft-Pedaling Cancer Prevention

We celebrate those who beat cancer ... but ignore efforts to prevent it
By Bill O'Driscoll
News cycle: Stories about Lance Armstrong's recovery ignored the fast-rising incidence of testicular cancer.
In October 1996, Lance Armstrong, then 25 and the world's seventh-ranked professional bicyclist, learned he had testicular cancer. The cancer had spread to his lungs, brain and abdomen. He was given a 40 percent chance of survival. 
"I intend to beat this disease," he told reporters.
Armstrong survived, of course -- the brain surgery, the grueling rounds of chemotherapy -- and went on to seven straight Tour de France titles.
Armstrong's recovery was received joyously. Headlines like "With Each Day, a Triumph" were standard; thousands of fan letters and emails arrived weekly. In 1999, Armstrong told Bicycling magazine, "The cancer -- I owe my life to it. … I wouldn't be married. I wouldn't have a kid on the way. And I'm a [better] rider."
News accounts noted everything from testicular cancer's predilection for young men to survival tips from psychologists. But readers were rarely, if ever, informed that testicular cancer was becoming increasingly common. In the 20 years preceding Armstrong's diagnosis, its incidence in the U.S. had risen by 41 percent. And it has kept rising: By 2007, testicular cancer was 75 percent more common than in 1975. And no one knows why.
Armstrong himself seemed disinterested in what causes testicular cancer. While his Lance Armstrong Foundation, created in 1997, has distributed countless yellow "Livestrong" wristbands, like most cancer initiatives it's all about supporting cancer sufferers, not pursuing root causes.
Or, as Armstrong said shortly after his diagnosis: "I don't want to waste my time saying, ‘Why me?' I have a problem and I want to fix it."

Spinning the Wheels
It's hard to believe we'd need to argue that preventing illness is preferable to trying to cure it. It's as if we'd abandoned sewage-treatment systems because we have antibiotics for cholera.
And curing cancer is proving much harder than developing antibiotics.
Forty years into America's "war on cancer," you're 50 percent more likely to get cancer than when it began. Childhood cancer rates have grown steadily for decades, according to National Cancer Institute statistics, and cancer is rising in people under 50. Yet the Institute's own funding patterns emphasizes new treatments over prevention. 
For instance, in 2010, the National Cancer Institute spent $364 million on prevention programs -- and $1.16 billion on treatment research. (Asked about research priorities, an NCI spokesperson said "grants are awarded on a competitive basis" and research categories "[don't] fully capture the complete range of research objectives" because some research applies in multiple categories.)
Treatment is likewise the focus of the vast majority of funds raised by your average "race for the cure" fundraiser.
Treatment funding has done some good: Childhood cancer and testicular cancer, for example -- both virtual death sentences as recently as the 1970s -- are now mostly treatable. And the rate at which Americans die from cancer has declined from its early-1990s peak.
However, mortality remains just 6 percent lower than in 1950. And providing cancer care is expensive. Spending on treatment has quadrupled in the past three decades. Last year, it reached $125 billion -- 5 percent of the national medical bill.
While that spending is driven largely by the aging population, caring for younger sufferers like Lance Armstrong is pricier because treatment is usually more aggressive. Science magazine recently cited the case of a young father with stomach cancer: His four months of end-of-life treatment cost $350,000.
Moreover, treating cancer is hard -- both on patients and on researchers, who've spent decades searching for a cure. Cancer cells don't mutate just once; they keep mutating, and can develop resistance to drugs.
So why not put more effort into prevention?
It's not a new question. 
In his controversial 1979 book The Politics of Cancer, Samuel Epstein, a professor of environmental medicine, asserted that "cancer is caused mainly by exposure to chemicals or physical agents in the environment." If those chemicals were removed, he argued, cancer would be "essentially preventable." But he charged mainstream experts with downplaying the role of industrial carcinogens -- and with pursuing lucrative treatments for cancer at the expense of prevention. Epstein cited ties between what he called "the cancer establishment" and the petrochemical and pharmaceutical industries; in the 1980s, for instance, the NCI Executive Cancer Panel was chaired by oil magnate Armand Hammer.
Epstein's attacks were roundly criticized by the medical establishment. But little has changed, says epidemiologist Devra Davis, author of The Secret History of the War on Cancer.
"The National Institutes of Health," she quips, "really should be called the National Institutes of Disease."

Why Don't We Know More?
Popular culture too prefers "beating" cancer to sussing its source: For every movie about what carcinogens do, like Erin Brockovich, there are 10 Brian's Songs or 50/50s, celebrating cancer's noble victims or plucky survivors.
Public officials follow suit. When President Richard Nixon was pushing the National Cancer Act, in 1971, he issued a 1,300-word statement. While it briefly acknowledged evidence that "human cancers can be prevented by avoiding exposure to certain chemicals," just 100 words of the statement concerned prevention. (Seven years after the surgeon general's announcement that cigarettes cause cancer, Nixon's statement didn't even mention smoking.) Nixon's repeated references to a "cancer cure," meanwhile, signaled the chief goal.
Critics say those priorities are no accident. As difficult as curing cancer might be, it could be harder to reduce the malignant growth of special interests.
More scientists are now, like Epstein, raising alarms that synthetic chemicals drive cancer. Consider testicular cancer. Studies have linked exposure to hormone-mimicking chemicals (like those found in some pesticides and plastics) to reproductive abnormalities including undescended testicles, a cancer risk factor. Meanwhile, a 2008 study suggested that a byproduct of the pesticide DDT (still found in most Americans' bloodstreams) increases the risk of testicular cancer.
And DDT is just one of at least 84,000 synthetic chemicals. Some are known carcinogens; the vast majority remain untested for health effects.
But passing laws to reduce exposure to such chemicals is difficult, partly because of the chemical industry's political influence. According to, the industry employs nearly 500 federal lobbyists and regularly spends $50 million a year on lobbying; top spenders this year include Dow Chemical, the American Chemistry Council and DuPont Co. 
Epidemiologist Davis says she and other researchers who confront industry face threats to their funding or careers. Her Secret History of the War on Cancer documents the derailing of several researchers who explored tobacco or industrial pollutants. She cites, for instance, Wilhelm Hueper, whose pioneering research into industrial carcinogens got him fired by DuPont; he later worked for the National Cancer Institute, where industry pressure hamstrung his efforts until he left, in 1968.
When concerns about chemicals do arise, Davis observes, business interests take a page from the tobacco industry: They tout bought-and-paid-for studies showing their products are safe, and question the science behind the alarm bells. 
Consider BPA, a plastics additive that's caused cancer and reproductive problems in lab animals. For years, industry fought state-level bans on BPA in products like baby bottles and sippy cups; in 2009, the American Chemistry Council said that California's effort would "needlessly restrict consumer products deemed to be safe by scientific experts worldwide." In fact, there was some scientific concern about BPA, and a sign-off by the U.S. Food and Drug Administration was later revealed to have been heavily influenced by industry input. Then, just this past October, the ACC announced that manufacturers had quietly removed BPA from such products. "[T]hese products are not on the market. There is no need for parents or consumers to worry about them," said an ACC spokesman.
Davis now runs the Washington, D.C.-based Environmental Health Trust. "Our motto is ‘Making Prevention the Cure,'" she says. "No matter how much money we spend on finding and treating cancer, no matter how good we get at treating it … if we don't reduce the demand, we'll never win."
In the meantime, mystery chemicals continue to proliferate, at a clip not even Lance Armstrong could outrace.

Next week: The Toxins We Live In

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